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General NPI Number Information
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NPI Number | 1952515587
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Entity Type | Organization
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Legal Business Name | PREMIERE MEDICAL SUPPLY, INC.
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Dates
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Enumeration Date | 05/10/2007
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Last Update Date | 01/31/2008
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Provider Practice Location Address
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Address Line | 3614 MARKET PL SUITE 5
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City | BRYANT
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State | AR
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Zip | 72022-9166
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Country | US
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Telephone | 501-847-7800
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Fax | 501-847-7804
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Provider Business Mailing Address
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Address Line | 3614 MARKET PL SUITE 5
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City | BRYANT
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State | AR
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Zip | 72022-9166
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Country | US
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Telephone | 501-847-7800
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Fax | 501-847-7804
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Authorized Official
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Title or Position | PRESIDENT
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Name | MICHAEL SCOTT DINGER
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Credential | CRT
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Telephone | 501-847-7800
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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 | MG00839
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License Number State | AR
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