Provider Demographics
NPI:1821876285
Name:PRIME LANDING LLC
Entity Type:Organization
Organization Name:PRIME LANDING LLC
Other - Org Name:PRIME LANDING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TOMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-970-5269
Mailing Address - Street 1:4712 ROCKMOOR LN
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76116-8729
Mailing Address - Country:US
Mailing Address - Phone:214-970-5269
Mailing Address - Fax:
Practice Address - Street 1:640 TAYLOR ST STE 1200
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76102-4828
Practice Address - Country:US
Practice Address - Phone:214-970-5269
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-18
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty