Provider Demographics
NPI:1659438257
Name:PERFORMANCE EXCELLENCE CORPORATION
Entity Type:Organization
Organization Name:PERFORMANCE EXCELLENCE CORPORATION
Other - Org Name:PERFORMANCE EXCELLENCE MEDICAL SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MALINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:WALLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-558-2273
Mailing Address - Street 1:12002 RICHMOND AVE
Mailing Address - Street 2:700
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77082-2433
Mailing Address - Country:US
Mailing Address - Phone:281-558-2273
Mailing Address - Fax:281-558-2275
Practice Address - Street 1:12002 RICHMOND AVE
Practice Address - Street 2:700
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77082-2433
Practice Address - Country:US
Practice Address - Phone:281-558-2273
Practice Address - Fax:281-558-2275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2012-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0061279332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX151906801Medicaid
TX531185OtherDMEPOS
TX151907601Medicaid
TX531185OtherDMEPOS