Healthcare Provider Details

I. General information

NPI: 1073706875
Provider Name (Legal Business Name): PREMIER MEDICAL SUPPLIES & EQUIPMENT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2007
Last Update Date: 06/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1419A COLLEGE ST
OXFORD NC
27565-2578
US

IV. Provider business mailing address

1419A COLLEGE ST
OXFORD NC
27565-2578
US

V. Phone/Fax

Practice location:
  • Phone: 919-603-1811
  • Fax: 919-603-1911
Mailing address:
  • Phone: 919-690-0524
  • Fax: 919-603-1911

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 Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MRS. STEPHANIE DANIELLE HARRIS
Title or Position: PRESIDENT
Credential:
Phone: 919-690-0524