Organization
ILLUSION MEDICAL EQUIPMENT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIE C MITCHELL (OWNER)
(956) 661-8701
Entity
Organization
Contact information
Practice address
2208 PRIMROSE AVE, SUITE I-B, MCALLEN, TX 78504-4162
(956) 661-8701
Mailing address
2208 PRIMROSE AVE, SUITE I-B, MCALLEN, TX 78504-4162
(956) 661-8701
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
189637501
—
TX
05
—
189637502
—
TX
Enumeration date
04/18/2007
Last updated
08/16/2011
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