1699301093 NPI number — PRIORITYONE EMS AND MEDICAL SUPPLY, LLC

Table of content: (NPI 1699301093)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699301093 NPI number — PRIORITYONE EMS AND MEDICAL SUPPLY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRIORITYONE EMS AND MEDICAL SUPPLY, LLC
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:
6
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:
1699301093
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/12/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 182
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOWELL
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01853-0182
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-230-9668
Provider Business Mailing Address Fax Number:
866-253-8848

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
246 CRAWFORD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOWELL
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01854-1634
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-230-9668
Provider Business Practice Location Address Fax Number:
866-253-8848
Provider Enumeration Date:
03/17/2020

Additional Information

Authorized Official

Authorized Official Last Name:
PERKINS
Authorized Official First Name:
ANTHONY
Authorized Official Middle Name:
CLAUDE
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
978-230-9668

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332BN1400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BX2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 343900000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 17965 . This is a "PROVIDER LICENSE RI" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: E0912184 . This is a "PROVIDER LICENSE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 33999E . This is a "PROVIDER LICENSE NH" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 560555 . This is a "PROVIDER LICENSE FL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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