Provider Demographics
NPI:1376854430
Name:PROFESSIONAL MEDICAL WAREHOUSE, INC.
Entity Type:Organization
Organization Name:PROFESSIONAL MEDICAL WAREHOUSE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANGER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-325-9400
Mailing Address - Street 1:PO BOX 5785
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92263
Mailing Address - Country:US
Mailing Address - Phone:760-325-9400
Mailing Address - Fax:760-325-6438
Practice Address - Street 1:1775 E PALM CANYON DR
Practice Address - Street 2:SUITE #335
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92264-1613
Practice Address - Country:US
Practice Address - Phone:760-325-9400
Practice Address - Fax:760-325-6438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-23
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies