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General NPI Number Information
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NPI Number | 1891071387
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Entity Type | Organization
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Legal Business Name | PREMIER MEDICAL SUPPLY, INC.
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Dates
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Enumeration Date | 10/27/2011
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Last Update Date | 10/27/2011
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Provider Practice Location Address
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Address Line | 900 N MARKET BLVD SUITE H
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City | SACRAMENTO
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State | CA
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Zip | 95834-1264
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Country | US
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Telephone | 916-646-1600
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Fax | 916-646-1616
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Provider Business Mailing Address
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Address Line | 900 N MARKET BLVD SUITE H
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City | SACRAMENTO
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State | CA
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Zip | 95834-1264
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Country | US
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Telephone | 916-646-1600
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Fax | 916-646-1616
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Authorized Official
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Title or Position | VICE-PRESIDENT
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Name | MR. ALAN FRANCIS BETTENCOURT
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Credential |
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Telephone | 209-537-2882
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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 | 56332
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License Number State | CA
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