Provider Demographics
NPI:1831451434
Name:NATIONAL MEDICAL SOURCE LLC
Entity type:Organization
Organization Name:NATIONAL MEDICAL SOURCE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKEOWN
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:702-302-4142
Mailing Address - Street 1:1350 E FLAMINGO RD
Mailing Address - Street 2:# 3227
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-5263
Mailing Address - Country:US
Mailing Address - Phone:702-302-4142
Mailing Address - Fax:888-557-7931
Practice Address - Street 1:3790 PARADISE RD
Practice Address - Street 2:#125
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89169-5930
Practice Address - Country:US
Practice Address - Phone:702-302-4142
Practice Address - Fax:888-557-7931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-11
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies