Healthcare Provider Details

I. General information

NPI: 1265264360
Provider Name (Legal Business Name): PRI-MED HEALTHCARE SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2024
Last Update Date: 08/17/2024
Certification Date: 08/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 CORPORATE SQUARE BLVD STE 135
JACKSONVILLE FL
32216-1990
US

IV. Provider business mailing address

2121 CORPORATE SQUARE BLVD STE 135
JACKSONVILLE FL
32216-1990
US

V. Phone/Fax

Practice location:
  • Phone: 786-815-3251
  • Fax: 866-579-5123
Mailing address:
  • Phone: 786-815-3251
  • Fax: 866-579-5123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: DAINE DARBY
Title or Position: OWNER
Credential:
Phone: 786-815-3251