| NPI | 1558824607 |
|---|---|
| Doing Business As | PROVIDENCE MEDICAL SUPPLY |
| Entity Type | Organization |
| Authorized Contact | MODUPE IROROBEJE CEO 702-778-3072 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2019-04-06 |
| Last Update Date | 2019-04-06 |