Healthcare Provider Details

I. General information

NPI: 1730009044
Provider Name (Legal Business Name): PREMIER MEDICAL SUPPLY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2005 VALPARAISO ST
VALPARAISO IN
46383-3329
US

IV. Provider business mailing address

2005 VALPARAISO ST
VALPARAISO IN
46383-3329
US

V. Phone/Fax

Practice location:
  • Phone: 945-403-2756
  • Fax: 945-403-2756
Mailing address:
  • Phone: 945-403-2457
  • Fax: 945-403-2457

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MOHAMMAD SAAD HASSAN
Title or Position: PRESIDENT
Credential:
Phone: 945-403-2457