Healthcare Provider Details

I. General information

NPI: 1568073187
Provider Name (Legal Business Name): PREMIER COMMUNITY HEALTHCARE GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2020
Last Update Date: 05/17/2023
Certification Date: 05/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7509 STATE ROAD 52
HUDSON FL
34667-6788
US

IV. Provider business mailing address

PO BOX 232
DADE CITY FL
33526-0232
US

V. Phone/Fax

Practice location:
  • Phone: 352-518-2000
  • Fax: 352-567-0218
Mailing address:
  • Phone: 352-518-2000
  • Fax: 352-567-0218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH RESNICK
Title or Position: CEO
Credential:
Phone: 352-518-2000