Premier Medical Supply, LLC

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

PREMIER MEDICAL SUPPLY, LLC

Practice address

1545 Goodyear Dr Ste D
El Paso, TX 79936-6063

Phone

(915) 594-3333

Fax

(915) 594-3043

NPI assigned

Jul 26, 2011

Organization subpart

No

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

Authorized official

Name

Colette Radcliffe

Title

President

Phone

(915) 504-3111

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Cynthia Shaw Ivan, NP

  • Nurse Practitioner
  • El Paso, TX
  • NPI 1205936689
  NPD (past)

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

{
    "created_epoch": "1311638400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718064000000",
    "number": "1467730366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1545 GOODYEAR DR STE D",
            "city": "EL PASO",
            "state": "TX",
            "postal_code": "799366063",
            "telephone_number": "915-594-3333",
            "fax_number": "915-594-3043"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1545 GOODYEAR DR STE D",
            "city": "EL PASO",
            "state": "TX",
            "postal_code": "799366063",
            "telephone_number": "915-594-3333",
            "fax_number": "915-594-3043"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER MEDICAL SUPPLY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-07-26",
        "last_updated": "2024-06-11",
        "certification_date": "2024-06-11",
        "status": "A",
        "authorized_official_last_name": "RADCLIFFE",
        "authorized_official_first_name": "COLETTE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "915-504-3111"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "297995701",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Premier Foot and Ankle Specialist of Texas - Professional Association
• Premier Hand Therapy
• Premier Hand Therapy
• Premier Hand Therapy
• Premier Home Health Care, Inc.
• Premier Optical
• Premier Optical Incorporated
• Premier Path Home Care
• Premier Primary Care Clinic LLC
• Premier Workcare PLLC

• Durable Medical Equipment & Medical Supplies in El Paso, TX
• Providers in El Paso, TX by specialty
• Durable Medical Equipment & Medical Supplies in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2024; 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.