Healthcare Provider Details

I. General information

NPI: 1508969536
Provider Name (Legal Business Name): PREMIER TOTAL HEALTHCARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2415 HOLLYWOOD BLVD
HOLLYWOOD FL
33020-6605
US

IV. Provider business mailing address

2415 HOLLYWOOD BLVD
HOLLYWOOD FL
33020-6605
US

V. Phone/Fax

Practice location:
  • Phone: 954-456-0250
  • Fax: 954-456-0820
Mailing address:
  • Phone: 954-456-0250
  • Fax: 954-456-0820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH7202
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS5537
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberOS5537
License Number StateFL

VIII. Authorized Official

Name: KEVIN P MCGRATH
Title or Position: DC
Credential:
Phone: 954-456-0250