Provider Demographics
NPI:1598939001
Name:PROMINENT MEDICAL SUPPLIES
Entity Type:Organization
Organization Name:PROMINENT MEDICAL SUPPLIES
Other - Org Name:JOHN T. SHEEHAN
Other - Org Type:Other Name
Authorized Official - Title/Position:BUSINESS OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:T
Authorized Official - Last Name:SHEEHAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:401-710-9382
Mailing Address - Street 1:1 HIGH STREET
Mailing Address - Street 2:UNIT 6
Mailing Address - City:PASCOAG
Mailing Address - State:RI
Mailing Address - Zip Code:02859-2643
Mailing Address - Country:US
Mailing Address - Phone:401-710-9382
Mailing Address - Fax:
Practice Address - Street 1:1 HIGH STREET
Practice Address - Street 2:UNIT 6
Practice Address - City:PASCOAG
Practice Address - State:RI
Practice Address - Zip Code:02859-2643
Practice Address - Country:US
Practice Address - Phone:401-710-9382
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-15
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT332B00000X332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies