MEDICARE: VINCE PRIMO

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	171W00000X	Contractor	3-20562-7504-6	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	47-2971977	OTHER	TX	WE SELL THERAPUTIC HOT TUBS AND SWIM SPAS

General Provider Information

NPI Number	:	1316458847
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VINCE PRIMO

Provider Business Mailing Address
First Line	:	22315 GOSLING RD
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77389-4409
Country	:	US
Telephone Number	:	281-466-2618
Fax Number	:	281-466-2893

Provider Business Practice Location Address
First Line	:	22315 GOSLING RD
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77389-4409
Country	:	US
Telephone Number	:	281-466-2618
Fax Number	:	281-466-2893

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2017
Last Update Date	:	06/16/2018

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Directions to “ VINCE PRIMO ” Practice Location

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