Provider Demographics
NPI:1225248586
Name:PREMIER DME
Entity Type:Organization
Organization Name:PREMIER DME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LEONEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GUERRERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-380-6030
Mailing Address - Street 1:508 W CANTON RD STE B
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-6136
Mailing Address - Country:US
Mailing Address - Phone:956-380-6030
Mailing Address - Fax:956-383-2212
Practice Address - Street 1:508 W CANTON RD STE B
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-6136
Practice Address - Country:US
Practice Address - Phone:956-380-6030
Practice Address - Fax:956-383-2212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2010-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0088046332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX181427901Medicaid
TX181427903Medicaid
TX181427902Medicaid
TX181427903Medicaid