MEDICARE: PRIME MEDICAL SUPPLY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083612022
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIME MEDICAL SUPPLY INC

Provider Business Mailing Address
First Line	:	1261 CARBIDE DR
Second Line	:
City	:	CORONA
State	:	CA
Zip	:	92881-7269
Country	:	US
Telephone Number	:	951-278-9111
Fax Number	:	951-278-9909

Provider Business Practice Location Address
First Line	:	1261 CARBIDE DR
Second Line	:
City	:	CORONA
State	:	CA
Zip	:	92881-7269
Country	:	US
Telephone Number	:	951-278-9111
Fax Number	:	951-278-9909

Authorized Official
Title or Position	:	PRESIDENT
Name	:	N J DAVIS
Credential	:	RN PHN MSN
Telephone Number	:	951-278-9111

Provider Enumeration Date	:	07/13/2005
Last Update Date	:	06/25/2009

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Directions to “PRIME MEDICAL SUPPLY INC ” Practice Location

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