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General NPI Number Information
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NPI Number | 1780999318
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Entity Type | Organization
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Legal Business Name | PREMIER MEDICAL SUPPLY LLC
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Dates
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Enumeration Date | 08/06/2010
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Last Update Date | 05/11/2011
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Provider Practice Location Address
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Address Line | 1821 ROYAL AVE SUITE 5
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City | MONROE
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State | LA
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Zip | 71201-5721
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Country | US
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Telephone | 318-387-2488
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Fax | 318-387-2420
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Provider Business Mailing Address
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Address Line | 1821 ROYAL AVE SUITE 5
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City | MONROE
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State | LA
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Zip | 71201-5721
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Country | US
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Telephone | 318-387-2488
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Fax | 318-387-2420
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Authorized Official
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Title or Position | MEMBER/MANAGER
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Name | ROD MILLIMAN
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Credential |
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Telephone | 318-387-2488
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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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