Provider Demographics
NPI:1285667212
Name:PREMIUM MEDICAL SUPPLY & EQUIPMENT INC
Entity Type:Organization
Organization Name:PREMIUM MEDICAL SUPPLY & EQUIPMENT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:VALENTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-889-4839
Mailing Address - Street 1:PO BOX 1677
Mailing Address - Street 2:
Mailing Address - City:LUQUILLO
Mailing Address - State:PR
Mailing Address - Zip Code:00773-1677
Mailing Address - Country:US
Mailing Address - Phone:787-889-4839
Mailing Address - Fax:787-889-4839
Practice Address - Street 1:265 CALLE MUNOZ RIVERA
Practice Address - Street 2:
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738
Practice Address - Country:US
Practice Address - Phone:787-889-4839
Practice Address - Fax:787-889-4839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR5129300001Medicare NSC