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General NPI Number Information
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NPI Number | 1447794979
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Entity Type | Organization
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Legal Business Name | PREMIER HEALTHCARE DME SUPPLY LLC
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Dates
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Enumeration Date | 12/19/2016
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Last Update Date | 03/09/2017
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Provider Practice Location Address
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Address Line | 20851 E RITTENHOUSE RD STE E103
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City | QUEEN CREEK
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State | AZ
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Zip | 85142-4493
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Country | US
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Telephone | 480-677-2800
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Fax | 888-503-3238
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Provider Business Mailing Address
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Address Line | 20851 E RITTENHOUSE RD STE E103
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City | QUEEN CREEK
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State | AZ
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Zip | 85142-4493
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Country | US
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Telephone | 480-677-2800
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Fax | 888-503-3238
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | BRANDI M DUTRA
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Credential |
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Telephone | 480-622-0352
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 006493
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License Number State | AZ
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