Provider Demographics
NPI:1033490776
Name:PSI PREMIER SPECIALTIES, INC.
Entity Type:Organization
Organization Name:PSI PREMIER SPECIALTIES, INC.
Other - Org Name:MEDICAL EXPRESS, PSI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:LEONARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-371-1700
Mailing Address - Street 1:8800 SHOAL CREEK BLVD
Mailing Address - Street 2:STE B
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78757-6818
Mailing Address - Country:US
Mailing Address - Phone:512-371-1700
Mailing Address - Fax:512-371-1754
Practice Address - Street 1:1825 TROUP HWY
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-5870
Practice Address - Country:US
Practice Address - Phone:903-526-6300
Practice Address - Fax:903-526-6301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-08
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1000690332B00000X
TX101372335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX101372OtherTEXAS BOARD OF ORTHOTICS AND PROSTHETICS LICENSE