Provider Demographics
NPI:1871047829
Name:RELIANT MEDICAL GROUP, LLC
Entity type:Organization
Organization Name:RELIANT MEDICAL GROUP, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:CARDENAS-SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-719-9042
Mailing Address - Street 1:9831 VENUS LAKE CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89178-5549
Mailing Address - Country:US
Mailing Address - Phone:702-719-9042
Mailing Address - Fax:
Practice Address - Street 1:3111 S VALLEY VIEW BLVD
Practice Address - Street 2:SUITE A-220
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-8317
Practice Address - Country:US
Practice Address - Phone:702-719-9042
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-08
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV20161386806332B00000X, 332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies