NPIMap

Organization Active NPI

Ideal Diabetic Supplies LLC

  • Durable Medical Equipment & Medical Supplies
  • Henderson, NV
National Provider Identifier
1841596129
Registry record updated Feb 2, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
License
NV20101840350 Issued in NV
Legal business name
IDEAL DIABETIC SUPPLIES LLC
Practice address
3031 Scenic Valley Way
Henderson, NV 89052-3092
Phone
(702) 443-5878
Fax
(888) 591-9874
NPI assigned
Feb 2, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 2, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Robert Brokaw
Title
Manager
Phone
(702) 443-5878

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X NV20101840350 NV Primary

Addresses

Primary practice location

3031 Scenic Valley Way
Henderson, NV 89052-3092

Mailing address

3031 Scenic Valley Way
Henderson, NV 89052-3092
Phone (702) 443-5878

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1296604800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1296604800000",
    "number": "1841596129",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3031 SCENIC VALLEY WAY",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890523092",
            "telephone_number": "702-443-5878",
            "fax_number": "888-591-9874"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3031 SCENIC VALLEY WAY",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890523092",
            "telephone_number": "702-443-5878",
            "fax_number": "888-591-9874"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDEAL DIABETIC SUPPLIES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-02-02",
        "last_updated": "2011-02-02",
        "status": "A",
        "authorized_official_last_name": "BROKAW",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "702-443-5878",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NV",
            "license": "NV20101840350",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Henderson, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.