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General NPI Number Information
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NPI Number | 1790392884
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Entity Type | Organization
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Legal Business Name | PREMIER MEDICAL SUPPLY AND EQUIPMENT LLC
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Dates
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Enumeration Date | 09/23/2020
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Last Update Date | 12/01/2022
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Provider Practice Location Address
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Address Line | 1623 EMBASSY DR APT 202
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City | WEST PALM BEACH
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State | FL
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Zip | 33401-1918
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Country | US
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Telephone | 631-617-1205
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Fax |
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Provider Business Mailing Address
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Address Line | 2028 HARRISON ST STE 201-8
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City | HOLLYWOOD
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State | FL
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Zip | 33020-7845
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Country | US
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Telephone | 754-263-2962
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Fax |
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Authorized Official
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Title or Position | MEMBER MANAGER
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Name | JONATHAN COLTON
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Credential |
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Telephone | 631-617-1205
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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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