Prime Source Medical Services, Inc

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

00213555 Issued in LA

Legal business name

PRIME SOURCE MEDICAL SERVICES, INC

Practice address

2715 Mackey PL Ste 116
Shreveport, LA 71118-2528

Phone

(318) 687-6776

Fax

(318) 687-6996

NPI assigned

Apr 21, 2008

Organization subpart

No

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

Authorized official

Name

Mr. Jade U Irondi

Title

President

Phone

(318) 687-6776

Specialties & licenses 2

Addresses

Locations

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

{
    "created_epoch": "1208736000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208736000000",
    "number": "1902070964",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2715 MACKEY PL STE 116",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711182528",
            "telephone_number": "318-687-6776",
            "fax_number": "318-687-6996"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2715 MACKEY PL STE 116",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711182528",
            "telephone_number": "318-687-6776",
            "fax_number": "318-687-6996"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIME SOURCE MEDICAL SERVICES, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-21",
        "last_updated": "2008-04-21",
        "status": "A",
        "authorized_official_last_name": "IRONDI",
        "authorized_official_first_name": "JADE",
        "authorized_official_middle_name": "U",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "318-687-6776",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "LA",
            "license": "00213555",
            "primary": true
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carolyn Baxter Priddy, RN
• Phillip M Priddy, CRNA
• Pride Patient Transportation,LLC
• Lashunda Prim
• Primary Care at Home of Louisiana, LLC
• Jennifer Prime, MD
• Jeremy Paul Prime, CRNA
• Jill Richie Prime, CRNA
• Brian C Primeaux
• Primecare Direct LLC

• Durable Medical Equipment & Medical Supplies in Shreveport, LA
• Providers in Shreveport, LA by specialty
• Durable Medical Equipment & Medical Supplies in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2008; 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.