Provider Demographics
NPI:1790392884
Name:PREMIER MEDICAL SUPPLY AND EQUIPMENT LLC
Entity Type:Organization
Organization Name:PREMIER MEDICAL SUPPLY AND EQUIPMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:COLTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-617-1205
Mailing Address - Street 1:2028 HARRISON ST STE 201-8
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020-7845
Mailing Address - Country:US
Mailing Address - Phone:754-263-2962
Mailing Address - Fax:
Practice Address - Street 1:1623 EMBASSY DR APT 202
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-1918
Practice Address - Country:US
Practice Address - Phone:631-617-1205
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-23
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies