Organization
PREMIEREMED LLC
Active
Other names
Clementson Medical
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTOPHER S CLEMENTSON (OWNER)
(804) 203-8512
Entity
Organization
Contact information
Practice address
1664 ANDERSON HWY STE B, POWHATAN, VA 23139-8056
(804) 203-8512
(804) 956-3152
Mailing address
1664 ANDERSON HWY STE B, POWHATAN, VA 23139-8056
(804) 314-8890
(804) 956-3152
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
0206010019
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0206010019
DME LICENSE
VA
Enumeration date
02/16/2017
Last updated
05/12/2020
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