MEDICARE: PLATINUM MEDICAL MANAGEMENT, 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	:	1619272820
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PLATINUM MEDICAL MANAGEMENT, LLC

Provider Business Mailing Address
First Line	:	23890 COPPERHILL DR
Second Line	:	#101
City	:	VALENCIA
State	:	CA
Zip	:	91354-1701
Country	:	US
Telephone Number	:	661-554-7710
Fax Number	:	661-554-7711

Provider Business Practice Location Address
First Line	:	23890 COPPERHILL DR
Second Line	:	#101
City	:	VALENCIA
State	:	CA
Zip	:	91354-1701
Country	:	US
Telephone Number	:	661-554-7710
Fax Number	:	661-554-7711

Authorized Official
Title or Position	:	OPERATIONS MANAGER
Name	:	MR. JEFF L SIMS
Credential	:
Telephone Number	:	661-554-7710

Provider Enumeration Date	:	01/19/2011
Last Update Date	:	01/19/2011

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