1619230349 NPI number — PREMIER HEALTHCARE SERVICES, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619230349 NPI number — PREMIER HEALTHCARE SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PREMIER HEALTHCARE SERVICES, LLC
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:
6
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:
1619230349
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/19/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 INTERSTATE NORTH PKWY SE STE 1600
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30339-5047
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-248-8740
Provider Business Mailing Address Fax Number:
626-204-7950

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 BURNETT AVE
Provider Second Line Business Practice Location Address:
SUITE 435
Provider Business Practice Location Address City Name:
CONCORD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94520-2000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
925-356-3333
Provider Business Practice Location Address Fax Number:
888-960-0957
Provider Enumeration Date:
06/18/2012

Additional Information

Authorized Official

Authorized Official Last Name:
WHITESIDE
Authorized Official First Name:
VICKI
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR, REGULATORY LICENSING
Authorized Official Telephone Number:
770-248-8740

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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