MEDICARE: PRIMERA DEVELOPMENT CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1265741995
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIMERA DEVELOPMENT CORPORATION

Provider Business Mailing Address
First Line	:	14330 CYPRESS FALLS DR
Second Line	:
City	:	CYPRESS
State	:	TX
Zip	:	77429-1996
Country	:	US
Telephone Number	:	281-655-4506
Fax Number	:	281-655-4506

Provider Business Practice Location Address
First Line	:	14330 CYPRESS FALLS DR
Second Line	:
City	:	CYPRESS
State	:	TX
Zip	:	77429-1996
Country	:	US
Telephone Number	:	281-655-4506
Fax Number	:	281-655-4506

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	DR. JOHN C MGBERE
Credential	:	PH.D.
Telephone Number	:	832-273-5048

Provider Enumeration Date	:	09/29/2010
Last Update Date	:	09/29/2010

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