Provider Demographics
NPI:1356862502
Name:PREMIER DME OF TEXAS
Entity Type:Organization
Organization Name:PREMIER DME OF TEXAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:
Authorized Official - Last Name:WAGNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-701-9811
Mailing Address - Street 1:PO BOX 7596
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77270-7596
Mailing Address - Country:US
Mailing Address - Phone:713-701-9811
Mailing Address - Fax:
Practice Address - Street 1:22802 ELSINORE DR
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-1645
Practice Address - Country:US
Practice Address - Phone:713-213-7866
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-28
Last Update Date:2017-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty