Provider Demographics
NPI:1184693343
Name:PRIME CARE MEDICAL SUPPLIES INC.
Entity type:Organization
Organization Name:PRIME CARE MEDICAL SUPPLIES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:AMICO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-447-0093
Mailing Address - Street 1:12 HOMESTEAD DRIVE
Mailing Address - Street 2:
Mailing Address - City:WELLS
Mailing Address - State:ME
Mailing Address - Zip Code:04090
Mailing Address - Country:US
Mailing Address - Phone:207-646-2102
Mailing Address - Fax:207-646-7066
Practice Address - Street 1:12 HOMESTEAD DRIVE
Practice Address - Street 2:
Practice Address - City:WELLS
Practice Address - State:ME
Practice Address - Zip Code:04090
Practice Address - Country:US
Practice Address - Phone:207-646-2102
Practice Address - Fax:207-646-7066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-17
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
ME332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
1367OtherCARE CENTRIX
0343400OtherBLUE CROSS OF NH
ME154380000Medicaid
622851OtherBLUE CROSS OF VIRGINIA
ME154380000Medicaid
622851OtherBLUE CROSS OF VIRGINIA