=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871711903
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PREMIER MEDICAL INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/23/2007
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2900 N GOVERNMENT WAY
-----------------------------------------------------
City | COEUR D ALENE
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83815-3751
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-371-8409
-----------------------------------------------------
Fax | 800-372-0016
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2900 N GOVERNMENT WAY
-----------------------------------------------------
City | COEUR D ALENE
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83815-3751
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-371-8409
-----------------------------------------------------
Fax | 800-372-0016
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRES.
-----------------------------------------------------
Name | MR. CRAIG EVAN NORDLIE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 800-371-8409
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | ID
-----------------------------------------------------