Provider Demographics
NPI:1801008644
Name:PRIMESOURCE HEALTHCARE SYSTEMS, INC.
Entity type:Organization
Organization Name:PRIMESOURCE HEALTHCARE SYSTEMS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:FLEMING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-580-5928
Mailing Address - Street 1:775 WAUKEGAN RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-4342
Mailing Address - Country:US
Mailing Address - Phone:847-580-5928
Mailing Address - Fax:847-267-9440
Practice Address - Street 1:4449 EASTON WAY
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43219-6093
Practice Address - Country:US
Practice Address - Phone:800-317-0711
Practice Address - Fax:847-267-9440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
0579450001OtherDMERC GROUP NUMBER