# PRIME MEDICAL SUPPLY INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1083612022
- **Authorized official:** N J DAVIS RN PHN MSN (PRESIDENT)
- **Authorized official phone:** (951) 278-9111

## Contact information

- **Practice address:** 1261 CARBIDE DR, CORONA, CA 92881-7269
- **Practice address phone:** (951) 278-9111
- **Practice address fax:** (951) 278-9909
- **Mailing address:** 1261 CARBIDE DR, CORONA, CA 92881-7269
- **Mailing address phone:** (951) 278-9111
- **Mailing address fax:** (951) 278-9909

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | Yes |

## Other

- **Enumeration date:** 07/13/2005
- **Last updated:** 06/25/2009