MEDICARE: PREMIER HEALTHCARE DME SUPPLY LLC

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	207Q00000X	Family Medicine Physician	006493	AZ

General Provider Information

NPI Number	:	1447794979
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIER HEALTHCARE DME SUPPLY LLC

Provider Business Mailing Address
First Line	:	20851 E RITTENHOUSE RD STE E103
Second Line	:
City	:	QUEEN CREEK
State	:	AZ
Zip	:	85142-4493
Country	:	US
Telephone Number	:	480-677-2800
Fax Number	:	888-503-3238

Provider Business Practice Location Address
First Line	:	20851 E RITTENHOUSE RD STE E103
Second Line	:
City	:	QUEEN CREEK
State	:	AZ
Zip	:	85142-4493
Country	:	US
Telephone Number	:	480-677-2800
Fax Number	:	888-503-3238

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	BRANDI M DUTRA
Credential	:
Telephone Number	:	480-622-0352

Provider Enumeration Date	:	12/19/2016
Last Update Date	:	03/09/2017

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