Provider Demographics
NPI:1124029962
Name:PRIME MEDICAL SUPPLY, INC.
Entity Type:Organization
Organization Name:PRIME MEDICAL SUPPLY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LANE
Authorized Official - Middle Name:K
Authorized Official - Last Name:MADDOCK
Authorized Official - Suffix:
Authorized Official - Credentials:AT,C
Authorized Official - Phone:406-252-7225
Mailing Address - Street 1:PO BOX 50305
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59105-0305
Mailing Address - Country:US
Mailing Address - Phone:406-252-7225
Mailing Address - Fax:
Practice Address - Street 1:1040 S 24TH ST W
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-6406
Practice Address - Country:US
Practice Address - Phone:406-252-7225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-02
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0562094Medicaid
MT0883910001Medicare ID - Type Unspecified