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General NPI Number Information
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NPI Number | 1083513469
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Entity Type | Organization
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Legal Business Name | PREMIERA SERVICE & SUPPLY
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Dates
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Enumeration Date | 11/03/2026
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Last Update Date | 11/04/2026
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Provider Practice Location Address
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Address Line | 7800 W OUTER DR STE 81
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City | DETROIT
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State | MI
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Zip | 48235-3461
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Country | US
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Telephone | 517-459-8066
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Fax |
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Provider Business Mailing Address
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Address Line | 2501 CHATHAM RD STE 4259
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City | SPRINGFIELD
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State | IL
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Zip | 62704-4188
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Country | US
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Telephone | 517-459-8066
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | FLORA T QUITUISACA
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Credential |
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Telephone | 517-459-8066
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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