MEDICARE: PRIME HEALTH MEDICAL SUPPLIES

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	332BC3200X	Customized Equipment (DME)
2	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)
3	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1902309644
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIME HEALTH MEDICAL SUPPLIES

Provider Business Mailing Address
First Line	:	8916 ROOSEVELT AVE
Second Line	:
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-7857
Country	:	US
Telephone Number	:	718-446-2300
Fax Number	:	718-446-2303

Provider Business Practice Location Address
First Line	:	8916 ROOSEVELT AVE
Second Line	:
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-7857
Country	:	US
Telephone Number	:	718-446-2300
Fax Number	:	718-446-2303

Authorized Official
Title or Position	:	OPS MRG
Name	:	ELLA ABUBAKAR
Credential	:
Telephone Number	:	718-446-2300

Provider Enumeration Date	:	03/08/2018
Last Update Date	:	03/08/2018

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Directions to “PRIME HEALTH MEDICAL SUPPLIES ” Practice Location

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