MEDICARE: PREMIER FAMILY HEALTH CARE SERVICES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251B00000X	Case Management Agency
2	251B00000X	Case Management Agency	MHL-042-052	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	019YW	OTHER	NC	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	8388	OTHER	NC	LME PROVIDER NUMBER

General Provider Information

NPI Number	:	1356363493
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIER FAMILY HEALTH CARE SERVICES, LLC

Provider Business Mailing Address
First Line	:	1704 HWY 158
Second Line	:
City	:	ROANOKE RAPIDS
State	:	NC
Zip	:	27870-8378
Country	:	US
Telephone Number	:	252-519-2273
Fax Number	:	252-535-2399

Provider Business Practice Location Address
First Line	:	1704 HWY 158
Second Line	:
City	:	ROANOKE RAPIDS
State	:	NC
Zip	:	27870-8378
Country	:	US
Telephone Number	:	252-519-2273
Fax Number	:	252-535-2399

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	MRS. STACIE MEDLIN SHEARIN
Credential	:	MSW
Telephone Number	:	252-519-2273

Provider Enumeration Date	:	07/25/2006
Last Update Date	:	05/26/2009

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Directions to “PREMIER FAMILY HEALTH CARE SERVICES, LLC ” Practice Location

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