Provider Demographics
NPI:1750727103
Name:PREMIER CARE MEDICAL SUPPLIES INC
Entity type:Organization
Organization Name:PREMIER CARE MEDICAL SUPPLIES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ABUMHENRE
Authorized Official - Middle Name:KELVIN
Authorized Official - Last Name:UKPEBOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-725-0580
Mailing Address - Street 1:10512 177TH ST
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11433-1811
Mailing Address - Country:US
Mailing Address - Phone:718-725-0580
Mailing Address - Fax:718-725-0581
Practice Address - Street 1:10512 177TH ST
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11433-1811
Practice Address - Country:US
Practice Address - Phone:718-725-0580
Practice Address - Fax:718-725-0581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-13
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies