Provider Demographics
NPI:1265024921
Name:PREMIER HOME MEDICAL LLC
Entity Type:Organization
Organization Name:PREMIER HOME MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLMOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-947-3096
Mailing Address - Street 1:1099 COLONIAL FORT DR
Mailing Address - Street 2:
Mailing Address - City:MONTVALE
Mailing Address - State:VA
Mailing Address - Zip Code:24122-2989
Mailing Address - Country:US
Mailing Address - Phone:540-947-3096
Mailing Address - Fax:
Practice Address - Street 1:1099 COLONIAL FORT DR
Practice Address - Street 2:
Practice Address - City:MONTVALE
Practice Address - State:VA
Practice Address - Zip Code:24122-2989
Practice Address - Country:US
Practice Address - Phone:540-947-3096
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-04
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies