Provider Demographics
NPI:1508176736
Name:PREMIER MEDICAL SUPPLY, INC.
Entity Type:Organization
Organization Name:PREMIER MEDICAL SUPPLY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:MR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:S
Authorized Official - Last Name:ELISEO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-252-1552
Mailing Address - Street 1:1001 N US HIGHWAY 1
Mailing Address - Street 2:SUITE 402
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33477-4482
Mailing Address - Country:US
Mailing Address - Phone:561-252-1552
Mailing Address - Fax:561-746-7383
Practice Address - Street 1:1001 N US HIGHWAY 1
Practice Address - Street 2:SUITE 402
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33477-4482
Practice Address - Country:US
Practice Address - Phone:561-252-1552
Practice Address - Fax:561-746-7383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-21
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies