Provider Demographics
NPI:1073746624
Name:PREMIER SOURCE MEDICAL SUPPLY INC.
Entity Type:Organization
Organization Name:PREMIER SOURCE MEDICAL SUPPLY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:SCHONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-570-0023
Mailing Address - Street 1:19 NE 50TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73105-1807
Mailing Address - Country:US
Mailing Address - Phone:405-570-0023
Mailing Address - Fax:800-693-9217
Practice Address - Street 1:19 NE 50TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73105-1807
Practice Address - Country:US
Practice Address - Phone:405-570-0023
Practice Address - Fax:800-693-9217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-31
Last Update Date:2009-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies