Provider Demographics
NPI:1891071387
Name:PREMIER MEDICAL SUPPLY, INC.
Entity Type:Organization
Organization Name:PREMIER MEDICAL SUPPLY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:BETTENCOURT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-537-2882
Mailing Address - Street 1:900 N MARKET BLVD
Mailing Address - Street 2:SUITE H
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95834-1264
Mailing Address - Country:US
Mailing Address - Phone:916-646-1600
Mailing Address - Fax:916-646-1616
Practice Address - Street 1:900 N MARKET BLVD
Practice Address - Street 2:SUITE H
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95834-1264
Practice Address - Country:US
Practice Address - Phone:916-646-1600
Practice Address - Fax:916-646-1616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-27
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56332332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA56332OtherMEDICAL DEVICE RETAILER