Provider Demographics
NPI:1952515587
Name:PREMIERE MEDICAL SUPPLY, INC.
Entity type:Organization
Organization Name:PREMIERE MEDICAL SUPPLY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:DINGER
Authorized Official - Suffix:
Authorized Official - Credentials:CRT
Authorized Official - Phone:501-847-7800
Mailing Address - Street 1:3614 MARKET PL
Mailing Address - Street 2:SUITE 5
Mailing Address - City:BRYANT
Mailing Address - State:AR
Mailing Address - Zip Code:72022-9166
Mailing Address - Country:US
Mailing Address - Phone:501-847-7800
Mailing Address - Fax:501-847-7804
Practice Address - Street 1:3614 MARKET PL
Practice Address - Street 2:SUITE 5
Practice Address - City:BRYANT
Practice Address - State:AR
Practice Address - Zip Code:72022-9166
Practice Address - Country:US
Practice Address - Phone:501-847-7800
Practice Address - Fax:501-847-7804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARMG00839332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5933460001Medicare NSC