Provider Demographics
NPI:1861033565
Name:PRIMARY MEDICAL SERVICES, LLC
Entity Type:Organization
Organization Name:PRIMARY MEDICAL SERVICES, LLC
Other - Org Name:PRIMARY TRANSIT SERVICES, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:QUINTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:RANDOLPH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-390-8850
Mailing Address - Street 1:206 EMERLING DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63121-1022
Mailing Address - Country:US
Mailing Address - Phone:314-390-8850
Mailing Address - Fax:
Practice Address - Street 1:206 EMERLING DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63121-1022
Practice Address - Country:US
Practice Address - Phone:314-390-8850
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-03
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172A00000XOther Service ProvidersDriverGroup - Single Specialty