Healthcare Provider Details

I. General information

NPI: 1730125873
Provider Name (Legal Business Name): PREMIER COMMUNITY HEALTH CARE GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14031 5TH ST
DODE CITY FL
33525
US

IV. Provider business mailing address

PO BOX 232
DODE CITY FL
33526-0232
US

V. Phone/Fax

Practice location:
  • Phone: 352-518-2000
  • Fax: 352-521-3091
Mailing address:
  • Phone: 352-518-2000
  • Fax: 352-567-5193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License NumberPH21294
License Number StateFL

VIII. Authorized Official

Name: MRS. DONNA B DELONG
Title or Position: CFO
Credential:
Phone: 352-567-1087