Provider Demographics
NPI:1578394862
Name:PRIMECARE DME SUPPLIERS LLC
Entity type:Organization
Organization Name:PRIMECARE DME SUPPLIERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TAIMUR
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-955-8327
Mailing Address - Street 1:414 OLE DIRT RD
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:VA
Mailing Address - Zip Code:22066
Mailing Address - Country:US
Mailing Address - Phone:703-955-8327
Mailing Address - Fax:
Practice Address - Street 1:414 OLE DIRT RD
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:VA
Practice Address - Zip Code:22066
Practice Address - Country:US
Practice Address - Phone:703-955-8327
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-09
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies