Healthcare Provider Details

I. General information

NPI: 1841908985
Provider Name (Legal Business Name): PREMIUM HEALTHCARE HOLDINGS, LLLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2022
Last Update Date: 11/08/2022
Certification Date: 11/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13353 SW 42ND ST
MIAMI FL
33175-3204
US

IV. Provider business mailing address

2400 SW 69TH AVE
MIAMI FL
33155-2919
US

V. Phone/Fax

Practice location:
  • Phone: 305-265-4441
  • Fax: 305-265-4844
Mailing address:
  • Phone: 305-746-1414
  • Fax: 305-265-4844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KEILA HOOVER
Title or Position: OWNER
Credential: MD
Phone: 305-265-4441