Provider Demographics
NPI:1013149582
Name:PRIORITY MEDICAL, LLC
Entity Type:Organization
Organization Name:PRIORITY MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF BUSINESS SYSTEMS
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:MACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-240-1229
Mailing Address - Street 1:2310 US HIGHWAY 84 W
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31601-5189
Mailing Address - Country:US
Mailing Address - Phone:229-262-8236
Mailing Address - Fax:229-244-9667
Practice Address - Street 1:664 RED BUD RD NE
Practice Address - Street 2:
Practice Address - City:CALHOUN
Practice Address - State:GA
Practice Address - Zip Code:30701-1963
Practice Address - Country:US
Practice Address - Phone:706-624-1560
Practice Address - Fax:706-624-1595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-18
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4582394Medicaid
GA886233706AMedicaid
GA5624170001Medicare NSC