Provider Demographics
NPI:1164544169
Name:PREMIUM MEDICAL EQUIPMENT & SUPPLIES
Entity Type:Organization
Organization Name:PREMIUM MEDICAL EQUIPMENT & SUPPLIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING AGENT
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:ANNA
Authorized Official - Last Name:MCNAB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-625-0680
Mailing Address - Street 1:1151 MAPUNAPUNA ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96819-4428
Mailing Address - Country:US
Mailing Address - Phone:808-836-9559
Mailing Address - Fax:
Practice Address - Street 1:1151 MAPUNAPUNA ST
Practice Address - Street 2:UNIT D9
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96819-4428
Practice Address - Country:US
Practice Address - Phone:808-836-9559
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI55102901Medicaid
HI0246223OtherHAWAII MEDICAL SERVICES
HI0246223OtherHAWAII MEDICAL SERVICES