Provider Demographics
NPI:1700230331
Name:PATRIOT MEDICAL SUPPLIES
Entity Type:Organization
Organization Name:PATRIOT MEDICAL SUPPLIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:FRAME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-286-0929
Mailing Address - Street 1:PO BOX 184
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROKE
Mailing Address - State:GA
Mailing Address - Zip Code:31004-0184
Mailing Address - Country:US
Mailing Address - Phone:516-286-0929
Mailing Address - Fax:
Practice Address - Street 1:519 W MAIN ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MO
Practice Address - Zip Code:63755-1740
Practice Address - Country:US
Practice Address - Phone:573-290-2841
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-20
Last Update Date:2017-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies