Provider Demographics
NPI:1194894758
Name:PRIME MEDICAL SUPPLY INC
Entity type:Organization
Organization Name:PRIME MEDICAL SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:PROPIETARY
Authorized Official - Phone:787-744-5040
Mailing Address - Street 1:PO BOX 1374
Mailing Address - Street 2:
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778-1374
Mailing Address - Country:US
Mailing Address - Phone:787-744-5040
Mailing Address - Fax:787-850-3800
Practice Address - Street 1:Q29 AVE L MUNOZ MARIN
Practice Address - Street 2:URB VILLA DEL CARMEN
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-6158
Practice Address - Country:US
Practice Address - Phone:787-744-5040
Practice Address - Fax:787-850-3800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5279180001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR=========OtherEIN NUMBER
PR5279180001Medicare NSC