Provider Demographics
NPI:1043234545
Name:PRIMECARE MEDICAL SUPPLY
Entity Type:Organization
Organization Name:PRIMECARE MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DELE
Authorized Official - Middle Name:CASSIUS
Authorized Official - Last Name:SILVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-424-0952
Mailing Address - Street 1:27013 LANGSIDE AVE STE C
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91351-2557
Mailing Address - Country:US
Mailing Address - Phone:661-424-0952
Mailing Address - Fax:661-424-0965
Practice Address - Street 1:27013 LANGSIDE AVE STE C
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91351-2557
Practice Address - Country:US
Practice Address - Phone:661-424-0952
Practice Address - Fax:661-424-0965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5308770001Medicare NSC