Provider Demographics
NPI:1922428549
Name:PSI PREMIER SPECIALTIES, INC.
Entity type:Organization
Organization Name:PSI PREMIER SPECIALTIES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:LEONARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-371-1700
Mailing Address - Street 1:8900 SHOAL CREEK BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78757-6853
Mailing Address - Country:US
Mailing Address - Phone:918-376-4180
Mailing Address - Fax:866-859-2645
Practice Address - Street 1:403 W 2ND AVE STE 101
Practice Address - Street 2:
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-3115
Practice Address - Country:US
Practice Address - Phone:918-376-4180
Practice Address - Fax:866-859-2645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-22
Last Update Date:2025-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX200546420AMedicaid