Organization
PRIME MEDICAL SUPPLY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
N J DAVIS RN PHN MSN (PRESIDENT)
(951) 278-9111
Entity
Organization
Contact information
Practice address
1261 CARBIDE DR, CORONA, CA 92881-7269
(951) 278-9111
(951) 278-9909
Mailing address
1261 CARBIDE DR, CORONA, CA 92881-7269
(951) 278-9111
(951) 278-9909
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
DME02170F
—
CA
Enumeration date
07/13/2005
Last updated
06/25/2009
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