Provider Demographics
NPI:1497378202
Name:PREMIER SERVICE LOGISTICS LLC
Entity Type:Organization
Organization Name:PREMIER SERVICE LOGISTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:NOWLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-553-5899
Mailing Address - Street 1:3106 MYSTIC FRST
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-3483
Mailing Address - Country:US
Mailing Address - Phone:713-553-5899
Mailing Address - Fax:
Practice Address - Street 1:2523 MCKEEVER RD
Practice Address - Street 2:
Practice Address - City:ROSHARON
Practice Address - State:TX
Practice Address - Zip Code:77583-2639
Practice Address - Country:US
Practice Address - Phone:281-654-6110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-27
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)