Provider Demographics
NPI:1760551220
Name:PLATINUM STANDARD HOLDINGS INC
Entity Type:Organization
Organization Name:PLATINUM STANDARD HOLDINGS INC
Other - Org Name:SOUTHLAND MEDICAL SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:WERNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-699-6334
Mailing Address - Street 1:27511 COMMERCE CENTER DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92590-2528
Mailing Address - Country:US
Mailing Address - Phone:951-699-6334
Mailing Address - Fax:951-676-7513
Practice Address - Street 1:27511 COMMERCE CENTER DR
Practice Address - Street 2:SUITE C
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-2528
Practice Address - Country:US
Practice Address - Phone:951-699-6334
Practice Address - Fax:951-676-7513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45853332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5955230001Medicare NSC