1427083534 NPI number — PREMIER MEDICAL GROUP, PSC

Table of content: (NPI 1427083534)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427083534 NPI number — PREMIER MEDICAL GROUP, PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PREMIER MEDICAL GROUP, PSC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PHYSICIANS AFFILIATED CARE, PSC
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427083534
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/06/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1919
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OWENSBORO
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42302-1919
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-926-2273
Provider Business Mailing Address Fax Number:
270-926-5200

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1030 BURLEW BLVD BLDG A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OWENSBORO
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42303-1735
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-926-2273
Provider Business Practice Location Address Fax Number:
270-684-3212
Provider Enumeration Date:
07/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BOARMAN
Authorized Official First Name:
JENNIFER
Authorized Official Middle Name:
Authorized Official Title or Position:
BILLING MANAGER
Authorized Official Telephone Number:
270-926-2273

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RE0101X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LG0600X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 200000370A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: CC5837 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000000057660 . This is a "ANTHEM BC/BS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 65903114 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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