Provider Demographics
NPI:1275079824
Name:PRIME CARE MEDICAL SUPPLIES, INC
Entity Type:Organization
Organization Name:PRIME CARE MEDICAL SUPPLIES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:AMICO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-447-0093
Mailing Address - Street 1:73 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:CALAIS
Mailing Address - State:ME
Mailing Address - Zip Code:04619-1684
Mailing Address - Country:US
Mailing Address - Phone:207-454-0265
Mailing Address - Fax:
Practice Address - Street 1:73 NORTH ST
Practice Address - Street 2:
Practice Address - City:CALAIS
Practice Address - State:ME
Practice Address - Zip Code:04619-1684
Practice Address - Country:US
Practice Address - Phone:207-454-0265
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-06
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies