Provider Demographics
NPI:1275269870
Name:PREMIER CREDENTIALING LLC
Entity Type:Organization
Organization Name:PREMIER CREDENTIALING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROMA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-474-9575
Mailing Address - Street 1:267 HIDDEN OAKS TRL
Mailing Address - Street 2:
Mailing Address - City:POTTSBORO
Mailing Address - State:TX
Mailing Address - Zip Code:75076-4109
Mailing Address - Country:US
Mailing Address - Phone:469-474-9575
Mailing Address - Fax:877-303-4532
Practice Address - Street 1:267 HIDDEN OAKS TRL
Practice Address - Street 2:
Practice Address - City:POTTSBORO
Practice Address - State:TX
Practice Address - Zip Code:75076-4109
Practice Address - Country:US
Practice Address - Phone:469-474-9575
Practice Address - Fax:877-303-4532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-26
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty