1629068564 NPI number — PRIORITY MEDICAL SUPPLY INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629068564 NPI number — PRIORITY MEDICAL SUPPLY INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRIORITY MEDICAL SUPPLY INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1629068564
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/28/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 8
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STEVINSON
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95374-0008
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
209-668-8723
Provider Business Mailing Address Fax Number:
209-669-6135

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
23763 W SECOND AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STEVINSON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95374-9998
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-668-8723
Provider Business Practice Location Address Fax Number:
209-669-6135
Provider Enumeration Date:
10/23/2005

Additional Information

Authorized Official

Authorized Official Last Name:
LEWIS
Authorized Official First Name:
JOE
Authorized Official Middle Name:
L
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
209-668-8723

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  102914 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: ZZZ06950Z . This is a "BLUE SHIELD PROVIDER NUMB" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: ========= . This is a "BLUE CROSS PROVIDER NUMBE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: ========= . This is a "TRICARE PROVIDER NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: DME03118F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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