Provider Demographics
NPI:1427732882
Name:PR MEDICAL SUPPLY
Entity type:Organization
Organization Name:PR MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:EMILIO
Authorized Official - Middle Name:JOSE
Authorized Official - Last Name:CONCEPCION GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-305-6251
Mailing Address - Street 1:20 AVE CAMPO RICO LOC
Mailing Address - Street 2:CENTRO COMERCIAL
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00983
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:20 AVE CAMPO RICO LOC
Practice Address - Street 2:CENTRO COMERCIAL
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00983
Practice Address - Country:US
Practice Address - Phone:813-305-6251
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies