Provider Demographics
NPI:1689483455
Name:LYMPHEDEMA AND MEDICAL SUPPLIES LLC
Entity type:Organization
Organization Name:LYMPHEDEMA AND MEDICAL SUPPLIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:BRITTANY
Authorized Official - Middle Name:
Authorized Official - Last Name:RONNEBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:702-580-8125
Mailing Address - Street 1:8355 LAGUNILLA AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89149-4730
Mailing Address - Country:US
Mailing Address - Phone:702-580-8125
Mailing Address - Fax:
Practice Address - Street 1:4215 S GRAND CANYON DR STE 101
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89147-7173
Practice Address - Country:US
Practice Address - Phone:702-448-6042
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-06
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies