Provider Demographics
NPI:1144385170
Name:PROMISE MEDICAL INC
Entity Type:Organization
Organization Name:PROMISE MEDICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:OLUYEMISI
Authorized Official - Middle Name:ESTHER
Authorized Official - Last Name:OLUSA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:480-632-5123
Mailing Address - Street 1:3002 N ARIZONA AVE STE 9
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-7158
Mailing Address - Country:US
Mailing Address - Phone:480-632-5123
Mailing Address - Fax:480-632-5124
Practice Address - Street 1:3002 N ARIZONA AVE STE 9
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-7158
Practice Address - Country:US
Practice Address - Phone:480-632-5123
Practice Address - Fax:480-632-5124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ20148164332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies