Provider Demographics
NPI:1235533662
Name:PRIORITY CARE MEDICAL SUPPLY, LLC
Entity Type:Organization
Organization Name:PRIORITY CARE MEDICAL SUPPLY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:P
Authorized Official - Last Name:CARSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-257-6740
Mailing Address - Street 1:1600 HIGHLAND DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:AMORY
Mailing Address - State:MS
Mailing Address - Zip Code:38821-1003
Mailing Address - Country:US
Mailing Address - Phone:662-257-6740
Mailing Address - Fax:662-257-2258
Practice Address - Street 1:1600 HIGHLAND DR
Practice Address - Street 2:SUITE B
Practice Address - City:AMORY
Practice Address - State:MS
Practice Address - Zip Code:38821-1003
Practice Address - Country:US
Practice Address - Phone:662-257-6740
Practice Address - Fax:662-257-2258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-14
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS13643/11.1332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies