Icon Medical LLC

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

ICON MEDICAL LLC

Practice address

2445 Fire Mesa St Ste 190
Las Vegas, NV 89128-9015

Phone

(702) 998-5800

NPI assigned

Feb 1, 2022

Organization subpart

No

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

Authorized official

Name

Jaime Cross Riley

Title

Coo

Phone

(702) 604-3195

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1643673600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1643673600000",
    "number": "1891448692",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2445 FIRE MESA ST STE 190",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891289015",
            "telephone_number": "702-998-5800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2445 FIRE MESA ST STE 190",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891289015",
            "telephone_number": "702-998-5800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ICON MEDICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-02-01",
        "last_updated": "2022-02-01",
        "certification_date": "2022-02-01",
        "status": "A",
        "authorized_official_last_name": "CROSS RILEY",
        "authorized_official_first_name": "JAIME",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "702-604-3195"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Durable Medical Equipment & Medical Supplies in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• Durable Medical Equipment & Medical Supplies in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2022; 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.