MEDICARE: PRIME MEDICAL SUPPLY, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332BC3200X	Customized Equipment (DME)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124029962
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIME MEDICAL SUPPLY, INC.

Provider Business Mailing Address
First Line	:	PO BOX 50305
Second Line	:
City	:	BILLINGS
State	:	MT
Zip	:	59105-0305
Country	:	US
Telephone Number	:	406-252-7225
Fax Number	:

Provider Business Practice Location Address
First Line	:	1040 S 24TH ST W
Second Line	:
City	:	BILLINGS
State	:	MT
Zip	:	59102-6406
Country	:	US
Telephone Number	:	406-252-7225
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	LANE K. MADDOCK
Credential	:	A.T.,C.
Telephone Number	:	406-252-7225

Provider Enumeration Date	:	08/02/2005
Last Update Date	:	08/14/2007

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