Organization
EMERALD LAKE, INC
Active
Other names
EMERALD MEDICAL SUPPLIES
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KELECHI AGWARA (DIRECTOR)
(702) 678-6267
Entity
Organization
Contact information
Practice address
5243 W CHARLESTON BLVD STE 9, LAS VEGAS, NV 89146-1304
(702) 678-6267
(702) 474-7051
Mailing address
5243 W CHARLESTON BLVD STE 9, LAS VEGAS, NV 89146-1304
(702) 678-6267
(702) 474-7051
Taxonomy
Speciality
Code
Description
License number
State
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
MP00814
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3302694
—
NV
Enumeration date
02/12/2007
Last updated
12/03/2015
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