Provider Demographics
NPI:1346331527
Name:PRIME MEDICAL, INC.
Entity Type:Organization
Organization Name:PRIME MEDICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BON
Authorized Official - Middle Name:ANELE
Authorized Official - Last Name:AGOHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-480-9007
Mailing Address - Street 1:8659 BALTIMORE NATIONAL PIKE
Mailing Address - Street 2:SUITE Q
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-4126
Mailing Address - Country:US
Mailing Address - Phone:410-480-9007
Mailing Address - Fax:410-480-9910
Practice Address - Street 1:8659 BALTIMORE NATIONAL PIKE
Practice Address - Street 2:SUITE Q
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-4126
Practice Address - Country:US
Practice Address - Phone:410-480-9007
Practice Address - Fax:410-480-9910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR2425332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies