Provider Demographics
NPI:1790478774
Name:PLATINUM MED SUPPLIES LLC
Entity Type:Organization
Organization Name:PLATINUM MED SUPPLIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMIR
Authorized Official - Middle Name:
Authorized Official - Last Name:ESSANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-276-7440
Mailing Address - Street 1:620 HILLCREST RD NW STE 100
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-6892
Mailing Address - Country:US
Mailing Address - Phone:800-276-7440
Mailing Address - Fax:
Practice Address - Street 1:620 HILLCREST RD NW STE 100
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-6892
Practice Address - Country:US
Practice Address - Phone:800-276-7440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-26
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies