Provider Demographics
NPI:1447794979
Name:PREMIER HEALTHCARE DME SUPPLY LLC
Entity Type:Organization
Organization Name:PREMIER HEALTHCARE DME SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRANDI
Authorized Official - Middle Name:M
Authorized Official - Last Name:DUTRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-622-0352
Mailing Address - Street 1:20851 E RITTENHOUSE RD STE E103
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-4493
Mailing Address - Country:US
Mailing Address - Phone:480-677-2800
Mailing Address - Fax:888-503-3238
Practice Address - Street 1:20851 E RITTENHOUSE RD STE E103
Practice Address - Street 2:
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85142-4493
Practice Address - Country:US
Practice Address - Phone:480-677-2800
Practice Address - Fax:888-503-3238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-19
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ006493207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty