Provider Demographics
NPI:1699783621
Name:PREMIER MEDICAL MOBILITY
Entity type:Organization
Organization Name:PREMIER MEDICAL MOBILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:WESLEY
Authorized Official - Last Name:CRAGG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-231-2955
Mailing Address - Street 1:581 W CAMPBELL ROAD
Mailing Address - Street 2:SUITE 114
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-3356
Mailing Address - Country:US
Mailing Address - Phone:972-231-2955
Mailing Address - Fax:972-231-2960
Practice Address - Street 1:581 W CAMPBELL ROAD
Practice Address - Street 2:SUITE 114
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-3356
Practice Address - Country:US
Practice Address - Phone:972-231-2955
Practice Address - Fax:972-231-2960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4662490001Medicare ID - Type Unspecified