Healthcare Provider Details

I. General information

NPI: 1518926799
Provider Name (Legal Business Name): PREMIER MEDICAL CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 E ASH ST
PERRY FL
32347-2029
US

IV. Provider business mailing address

315 E ASH ST
PERRY FL
32347-2029
US

V. Phone/Fax

Practice location:
  • Phone: 850-584-3278
  • Fax: 850-584-8171
Mailing address:
  • Phone: 850-584-3278
  • Fax: 850-584-8171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KHALIL M AFSH
Title or Position: OWNER
Credential: M.D.
Phone: 850-584-3278