Provider Demographics
NPI:1346478740
Name:PRISTINE MEDICAL LLC
Entity Type:Organization
Organization Name:PRISTINE MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:ST. LOUIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-757-4710
Mailing Address - Street 1:180 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:SAINT IGNACE
Mailing Address - State:MI
Mailing Address - Zip Code:49781-1602
Mailing Address - Country:US
Mailing Address - Phone:248-757-4710
Mailing Address - Fax:
Practice Address - Street 1:1502 W WEST MAPLE RD
Practice Address - Street 2:
Practice Address - City:WALLED LAKE
Practice Address - State:MI
Practice Address - Zip Code:48390-2945
Practice Address - Country:US
Practice Address - Phone:248-207-4358
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-24
Last Update Date:2009-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332900000XSuppliersNon-Pharmacy Dispensing Site