Healthcare Provider Details

I. General information

NPI: 1245798933
Provider Name (Legal Business Name): PREMIER CARE MEDICAL SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2019
Last Update Date: 11/25/2022
Certification Date: 11/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 W SUPERSTITION BLVD STE 101
APACHE JUNCTION AZ
85120-4127
US

IV. Provider business mailing address

212 W SUPERSTITION BLVD STE 101
APACHE JUNCTION AZ
85120-4127
US

V. Phone/Fax

Practice location:
  • Phone: 480-877-0120
  • Fax: 888-498-4092
Mailing address:
  • Phone: 480-877-0120
  • Fax: 888-498-4092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ALEXANDER DUPUIS
Title or Position: OWNER/ MANAGER
Credential: FNP-C
Phone: 480-877-0120