Provider Demographics
NPI:1891009122
Name:PREMIER MEDICAL DISTRIBUTION
Entity Type:Organization
Organization Name:PREMIER MEDICAL DISTRIBUTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-652-3353
Mailing Address - Street 1:3447 VIA FELICIDAD WAY
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-8144
Mailing Address - Country:US
Mailing Address - Phone:801-652-3353
Mailing Address - Fax:
Practice Address - Street 1:3447 VIA FELICIDAD WAY
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-8144
Practice Address - Country:US
Practice Address - Phone:801-652-3353
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-28
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies