Provider Demographics
NPI:1831311042
Name:PRIMESOURCE HEALTHCARE SYSTEMS, INC.
Entity Type:Organization
Organization Name:PRIMESOURCE HEALTHCARE SYSTEMS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:FLEMING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-267-8200
Mailing Address - Street 1:2100 EAST LAKE COOK ROAD
Mailing Address - Street 2:SUITE 1100
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-1815
Mailing Address - Country:US
Mailing Address - Phone:847-580-5954
Mailing Address - Fax:877-821-6402
Practice Address - Street 1:2100 EAST LAKE COOK ROAD
Practice Address - Street 2:SUITE 1100
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-1815
Practice Address - Country:US
Practice Address - Phone:847-580-5954
Practice Address - Fax:877-821-6402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0579450001Medicare NSC