Provider Demographics
NPI:1669444238
Name:PRIMEDICAL SUPPLY & EQUIPMENT, CORP.
Entity Type:Organization
Organization Name:PRIMEDICAL SUPPLY & EQUIPMENT, CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:HIRAM
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-773-0833
Mailing Address - Street 1:418 CALLE AGUEYBANA
Mailing Address - Street 2:URB EL VEDADO
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-3316
Mailing Address - Country:US
Mailing Address - Phone:787-773-0833
Mailing Address - Fax:787-773-0866
Practice Address - Street 1:418 CALLE AGUEYBANA
Practice Address - Street 2:URB EL VEDADO
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-3316
Practice Address - Country:US
Practice Address - Phone:787-773-0833
Practice Address - Fax:787-773-0866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4957300001Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUM