Provider Demographics
NPI:1487709762
Name:ACADEMY MEDICAL EQUIPMENT INC.
Entity type:Organization
Organization Name:ACADEMY MEDICAL EQUIPMENT INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:MARSHALL
Authorized Official - Last Name:PAUL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-382-9991
Mailing Address - Street 1:2400 N TENAYA WAY
Mailing Address - Street 2:SUITE 150
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-0420
Mailing Address - Country:US
Mailing Address - Phone:702-382-9991
Mailing Address - Fax:702-382-9636
Practice Address - Street 1:2400 N TENAYA WAY
Practice Address - Street 2:SUITE 150
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0420
Practice Address - Country:US
Practice Address - Phone:702-382-9991
Practice Address - Fax:702-382-9636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV119910332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV003302602Medicaid
NV003302602Medicaid