| Organization Name: | PRIME SOURCE MEDICAL SERVICES, INC |
| NPI Number: | 1902070964 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JADE U IRONDI (PRESIDENT) |
| Mailing Address: | 2715 Mackey Pl Ste 116 Shreveport |
| State: | LA US |
| Postal Code: | 711182528 |
| Phone Number: | 3186876776 |
| Fax Number: | 3186876996 |
| NPI Enumeration Date: | 04/21/2008 |
| NPI Last Update Date: | 04/21/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332B00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient |