Provider Demographics
NPI:1235261553
Name:PREMIER MEDICAL SUPPLY SERVICES, LLC
Entity Type:Organization
Organization Name:PREMIER MEDICAL SUPPLY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:K
Authorized Official - Last Name:FADIPE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-750-7885
Mailing Address - Street 1:2630 W. MANCHESTER BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90305-2434
Mailing Address - Country:US
Mailing Address - Phone:323-750-7885
Mailing Address - Fax:323-750-7890
Practice Address - Street 1:2630 W. MANCHESTER BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90305-2434
Practice Address - Country:US
Practice Address - Phone:323-750-7885
Practice Address - Fax:323-750-7890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2007-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46433332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5903440001Medicare NSC