Provider Demographics
NPI:1598896540
Name:PRIMECARE MEDICAL SUPPLY, INC.
Entity Type:Organization
Organization Name:PRIMECARE MEDICAL SUPPLY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DELE
Authorized Official - Middle Name:
Authorized Official - Last Name:SILVIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-860-4813
Mailing Address - Street 1:12146 SOUTH ST
Mailing Address - Street 2:SUITE F
Mailing Address - City:ARTESIA
Mailing Address - State:CA
Mailing Address - Zip Code:90701-6844
Mailing Address - Country:US
Mailing Address - Phone:562-860-4813
Mailing Address - Fax:562-860-4823
Practice Address - Street 1:12146 SOUTH ST
Practice Address - Street 2:SUITE F
Practice Address - City:ARTESIA
Practice Address - State:CA
Practice Address - Zip Code:90701-6844
Practice Address - Country:US
Practice Address - Phone:562-860-4813
Practice Address - Fax:562-860-4823
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46022332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5893590001Medicare NSC