Provider Demographics
NPI:1174529960
Name:PRIORITY MEDICAL SUPPLY, LLC
Entity type:Organization
Organization Name:PRIORITY MEDICAL SUPPLY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:WEINROTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-660-1718
Mailing Address - Street 1:PO BOX 267
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80104-0267
Mailing Address - Country:US
Mailing Address - Phone:303-660-1718
Mailing Address - Fax:303-660-1920
Practice Address - Street 1:405 S WILCOX ST
Practice Address - Street 2:STE 201
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104-1957
Practice Address - Country:US
Practice Address - Phone:303-660-1718
Practice Address - Fax:303-660-1920
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRIORITY MEDICAL SUPPLY, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-06-27
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO4259280001Medicare NSC