Provider Demographics
NPI:1811183148
Name:PHYSICIANS PREFERRED MED EQUIP SEV
Entity type:Organization
Organization Name:PHYSICIANS PREFERRED MED EQUIP SEV
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:K
Authorized Official - Last Name:MARK
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:229-242-1234
Mailing Address - Street 1:4274 N VALDOSTA RD
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-6814
Mailing Address - Country:US
Mailing Address - Phone:229-242-1234
Mailing Address - Fax:229-247-8110
Practice Address - Street 1:4274 N VALDOSTA RD
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-6814
Practice Address - Country:US
Practice Address - Phone:229-242-1234
Practice Address - Fax:229-247-8110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-20
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA3902130001Medicare NSC