Provider Demographics
NPI:1124568290
Name:PRIMARY CHOICE MEDICAL SUPPLIES LLC
Entity Type:Organization
Organization Name:PRIMARY CHOICE MEDICAL SUPPLIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHANE
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:CAMUS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:800-616-0327
Mailing Address - Street 1:4300 N UNIVERSITY DR STE B101
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33351-6243
Mailing Address - Country:US
Mailing Address - Phone:800-616-0327
Mailing Address - Fax:
Practice Address - Street 1:331 W CENTRAL AVE STE 242
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-2982
Practice Address - Country:US
Practice Address - Phone:800-616-0327
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-08
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies