Provider Demographics
NPI:1497860282
Name:PREMIER MEDICAL CORPORATION
Entity Type:Organization
Organization Name:PREMIER MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATIONS OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCARTHY
Authorized Official - Suffix:
Authorized Official - Credentials:AO
Authorized Official - Phone:727-530-7700
Mailing Address - Street 1:5055 E 48TH AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80216-3255
Mailing Address - Country:US
Mailing Address - Phone:303-650-4400
Mailing Address - Fax:303-292-0955
Practice Address - Street 1:5055 E 48TH AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80216-3255
Practice Address - Country:US
Practice Address - Phone:303-650-4400
Practice Address - Fax:303-292-0955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO08001828Medicaid
CO0641330001Medicare ID - Type UnspecifiedMEDICARE ID