1437503513 NPI number — PREMIER CHOICE HEALTHCARE AND EDUCATIONAL SERVICES

Table of content: (NPI 1437503513)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437503513 NPI number — PREMIER CHOICE HEALTHCARE AND EDUCATIONAL SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PREMIER CHOICE HEALTHCARE AND EDUCATIONAL SERVICES
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:
Provider Other Organization Name Type Code:
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:
1437503513
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/14/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 820472
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VICKSBURG
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39182-0472
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-620-4927
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1832 HOSPITAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JACKSON
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39204-3410
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-620-4927
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/14/2016

Additional Information

Authorized Official

Authorized Official Last Name:
CARSON
Authorized Official First Name:
CHRISTOPHER
Authorized Official Middle Name:
ALAN
Authorized Official Title or Position:
FAMILY NURSE PRACTITIONER
Authorized Official Telephone Number:
214-620-5860

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , with the licence number:  880514 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com