Healthcare Provider Details

I. General information

NPI: 1346247848
Provider Name (Legal Business Name): PRIME MEDICAL SUPPLY CO., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 07/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3915 BENSON AVE
BALTIMORE MD
21227-1406
US

IV. Provider business mailing address

3915 BENSON AVE
BALTIMORE MD
21227-1406
US

V. Phone/Fax

Practice location:
  • Phone: 410-787-2069
  • Fax: 410-787-0541
Mailing address:
  • Phone: 410-787-2069
  • Fax: 410-787-0541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number02995303
License Number StateMD

VIII. Authorized Official

Name: ROBERT R BURNS
Title or Position: PRESIDENT
Credential:
Phone: 410-787-2069