Provider Demographics
NPI:1871986166
Name:BETHESDA LAKE MEDICAL SUPPIES INC
Entity type:Organization
Organization Name:BETHESDA LAKE MEDICAL SUPPIES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:CHRISTIAN
Authorized Official - Last Name:BUBAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-882-0729
Mailing Address - Street 1:4610 ARVILLE ST
Mailing Address - Street 2:STE A
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89103-5357
Mailing Address - Country:US
Mailing Address - Phone:702-882-0729
Mailing Address - Fax:702-870-7878
Practice Address - Street 1:4610 ARVILLE ST
Practice Address - Street 2:STE A
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-5357
Practice Address - Country:US
Practice Address - Phone:702-882-0729
Practice Address - Fax:702-870-7878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-10
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies