Provider Demographics
NPI:1376842070
Name:PRIMED MEDICAL SUPPLY INC
Entity type:Organization
Organization Name:PRIMED MEDICAL SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:RAJOO
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-250-6069
Mailing Address - Street 1:6033 AIRLINE DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77076-4209
Mailing Address - Country:US
Mailing Address - Phone:713-697-3261
Mailing Address - Fax:713-697-3541
Practice Address - Street 1:6033 AIRLINE DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77076-4209
Practice Address - Country:US
Practice Address - Phone:713-697-3261
Practice Address - Fax:713-697-3541
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:M P HEALTHCARE MEDICAL SUPPLY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-03-21
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX016891601Medicaid