Provider Demographics
NPI:1164832002
Name:RED SEAL MEDICAL LLC
Entity type:Organization
Organization Name:RED SEAL MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:CRAIG
Authorized Official - Last Name:BROUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-410-7783
Mailing Address - Street 1:8887 W FLAMINGO RD
Mailing Address - Street 2:101
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89147-8743
Mailing Address - Country:US
Mailing Address - Phone:702-410-7783
Mailing Address - Fax:702-974-4447
Practice Address - Street 1:8887 W FLAMINGO RD
Practice Address - Street 2:101
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89147-8743
Practice Address - Country:US
Practice Address - Phone:702-410-7783
Practice Address - Fax:702-974-4447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-30
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV20131692195332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies