Prime Medical Supply Inc

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

PRIME MEDICAL SUPPLY INC

Practice address

1261 Carbide Dr
Corona, CA 92881-7269

Phone

(951) 278-9111

Fax

(951) 278-9909

NPI assigned

Jul 13, 2005

Last updated

Jun 25, 2009By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

N J Davis, RN PHN MSN

Title

President

Phone

(951) 278-9111

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1121212800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1245888000000",
    "number": "1083612022",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1261 CARBIDE DR",
            "city": "CORONA",
            "state": "CA",
            "postal_code": "928817269",
            "telephone_number": "951-278-9111",
            "fax_number": "951-278-9909"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1261 CARBIDE DR",
            "city": "CORONA",
            "state": "CA",
            "postal_code": "928817269",
            "telephone_number": "951-278-9111",
            "fax_number": "951-278-9909"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIME MEDICAL SUPPLY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-13",
        "last_updated": "2009-06-25",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "N",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "951-278-9111",
        "authorized_official_credential": "RN PHN MSN"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "DME02170F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kamesiau Damara Premmer, M.D
• Andrea Marie Price, PHYSICIAN ASSISTANT
• Cynthia Price
• Mackenzie Christine Price
• Primaria Medical Clinic
• Prime Motion Healthcare
• Prince of Peace Corporation
• Pro Vital Medical Group, Inc
• Professional Healthcare Associates, Inc. (Cavalry Ambulance)
• Prohealth Partners, a Medical Group, Inc.

• Durable Medical Equipment & Medical Supplies in Corona, CA
• Providers in Corona, CA by specialty
• Durable Medical Equipment & Medical Supplies in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.