MEDICARE: PRIMEDIC,LLC

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

General Provider Information

NPI Number	:	1457528234
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIMEDIC,LLC

Provider Business Mailing Address
First Line	:	380 PLEASANT ST
Second Line	:	SUITE LL2A
City	:	MALDEN
State	:	MA
Zip	:	02148-8123
Country	:	US
Telephone Number	:	781-322-3300
Fax Number	:	781-322-3303

Provider Business Practice Location Address
First Line	:	380 PLEASANT ST
Second Line	:	SUITE LL2A
City	:	MALDEN
State	:	MA
Zip	:	02148-8123
Country	:	US
Telephone Number	:	781-322-3300
Fax Number	:	781-322-3303

Authorized Official
Title or Position	:	PARTNER
Name	:	MR. ANTHONY O UDEH
Credential	:
Telephone Number	:	781-322-3300

Provider Enumeration Date	:	05/12/2008
Last Update Date	:	09/18/2009

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Directions to “PRIMEDIC,LLC ” Practice Location

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