Primesource of Michigan LLC

Primary specialty

PodiatristTaxonomy code 213E00000X

Legal business name

PRIMESOURCE OF MICHIGAN LLC

Practice address

2000 Town Ctr
Suite 1900
Southfield, MI 48075-1135

Phone

(800) 317-0711

Fax

(877) 821-6402

NPI assigned

May 29, 2013

Last updated

May 29, 2013By 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

Mr. David Fleming

Title

Ceo/President

Phone

(800) 317-0711

Specialties & licenses 4

Addresses

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Primesource Healthcare Systems, Inc.

  • Durable Medical Equipment & Medical Supplies
  • Buffalo Grove, IL
  • NPI 1831311042

  Member Of

  NPD member

Locations

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

{
    "created_epoch": "1369785600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1369785600000",
    "number": "1114364346",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2100 E LAKE COOK RD",
            "address_2": "SUITE 1100",
            "city": "BUFFALO GROVE",
            "state": "IL",
            "postal_code": "600891999",
            "telephone_number": "800-317-0711",
            "fax_number": "877-821-6402"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2000 TOWN CTR",
            "address_2": "SUITE 1900",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480751135",
            "telephone_number": "800-317-0711",
            "fax_number": "877-821-6402"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIMESOURCE OF MICHIGAN LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-05-29",
        "last_updated": "2013-05-29",
        "status": "A",
        "authorized_official_last_name": "FLEMING",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "CEO/PRESIDENT",
        "authorized_official_telephone_number": "800-317-0711",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Prime Laboratory, LLC
• Prime Mental Health Staffing, LLC
• Prime Mobile Care Incorporated
• Prime Toxicology, LLC
• Primemart Pharmacy, LLC
• Prince J Eubanks MD PC
• Angelia Kathlene Pringle, MS, LLPC
• Debra Pringle, LMSW
• Taylor Alise Prins
• Priority Home Health Care Inc

• Podiatrist in Southfield, MI
• Providers in Southfield, MI by specialty
• Podiatrist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.