Provider Demographics
NPI:1295023059
Name:PRIME MEDICAL SUPPLIES INC
Entity Type:Organization
Organization Name:PRIME MEDICAL SUPPLIES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:SITARAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-588-0707
Mailing Address - Street 1:600 N CONGRESS AVE STE 130
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33445-3433
Mailing Address - Country:US
Mailing Address - Phone:561-588-0707
Mailing Address - Fax:561-588-0747
Practice Address - Street 1:600 N CONGRESS AVE STE 130
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-3433
Practice Address - Country:US
Practice Address - Phone:561-588-0707
Practice Address - Fax:561-588-0747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-14
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
FLPH256003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004149501Medicaid