Provider Demographics
NPI:1457528234
Name:PRIMEDIC,LLC
Entity Type:Organization
Organization Name:PRIMEDIC,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:O
Authorized Official - Last Name:UDEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-322-3300
Mailing Address - Street 1:380 PLEASANT ST
Mailing Address - Street 2:SUITE LL2A
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-8123
Mailing Address - Country:US
Mailing Address - Phone:781-322-3300
Mailing Address - Fax:781-322-3303
Practice Address - Street 1:380 PLEASANT ST
Practice Address - Street 2:SUITE LL2A
Practice Address - City:MALDEN
Practice Address - State:MA
Practice Address - Zip Code:02148-8123
Practice Address - Country:US
Practice Address - Phone:781-322-3300
Practice Address - Fax:781-322-3303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-12
Last Update Date:2009-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA6235700001Medicare NSC