Provider Demographics
NPI:1174752034
Name:ILLUSION MEDICAL EQUIPMENT II, LLC
Entity type:Organization
Organization Name:ILLUSION MEDICAL EQUIPMENT II, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIE
Authorized Official - Middle Name:C
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:956-447-0225
Mailing Address - Street 1:1509 W BUSINESS 83 STE B
Mailing Address - Street 2:
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78596-5796
Mailing Address - Country:US
Mailing Address - Phone:956-447-0224
Mailing Address - Fax:956-447-0226
Practice Address - Street 1:1509 W BUSINESS 83 STE B
Practice Address - Street 2:
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596-5796
Practice Address - Country:US
Practice Address - Phone:956-447-0224
Practice Address - Fax:956-447-0226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-13
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX212537901Medicaid
TX212537902Medicaid
TX6373260001Medicare NSC