Emerald Lake, INC
Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies in Las Vegas, NV. Organization (NPI-2).
Details
- NPI
- 1578605341
- Entity type
- Organization (NPI-2)
- Legal business name
- Emerald Lake, INC
- Organization subpart
- No
- Enumeration date
- Feb 12, 2007
- Last updated
- Dec 3, 2015
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 332BX2000X | Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies | MP00814 | NV | Yes |
Other names
- Emerald Medical Supplies (Doing Business As)
Practice location
5243 W Charleston Blvd Ste 9Las Vegas, NV 89146-1304
Phone 702-678-6267 · Fax 702-474-7051
Mailing address
5243 W Charleston Blvd Ste 9Las Vegas, NV 89146-1304
Phone 702-678-6267 · Fax 702-474-7051
Authorized official
Kelechi Agwara
Director
7026786267
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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