Basic Information
| Provider Information | |||||||||
| NPI: | 1871781047 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PRIMED, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3 ENTERPRISE DR | ||||||||
| Address2: | SUITE 404 | ||||||||
| City: | SHELTON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064844694 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2039441940 | ||||||||
| FaxNumber: | 2034024196 | ||||||||
| Practice Location | |||||||||
| Address1: | 501 KINGS HWY E | ||||||||
| Address2: | SUITE 204 | ||||||||
| City: | FAIRFIELD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 068254867 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2036106300 | ||||||||
| FaxNumber: | 2036106347 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2007 | ||||||||
| LastUpdateDate: | 10/12/2007 | ||||||||
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| AuthorizedOfficialLastName: | BERTINI | ||||||||
| AuthorizedOfficialFirstName: | NICHOLAS | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT, PRIMED, LLC | ||||||||
| AuthorizedOfficialTelephone: | 2039441940 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
ID Information
| ID | Type | State | Issuer | Description | C02041 | 01 | CT | MEDICARE GROUP # | OTHER |