Organization
IDEAL DIABETIC SUPPLIES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT BROKAW (MANAGER)
(702) 443-5878
Entity
Organization
Contact information
Practice address
3031 SCENIC VALLEY WAY, HENDERSON, NV 89052-3092
(702) 443-5878
(888) 591-9874
Mailing address
3031 SCENIC VALLEY WAY, HENDERSON, NV 89052-3092
(702) 443-5878
(888) 591-9874
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
NV20101840350
NV
Other
Enumeration date
02/02/2011
Last updated
02/02/2011
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