Healthcare Provider Details

I. General information

NPI: 1316919491
Provider Name (Legal Business Name): PREMIER COMMUNITY HEALTHCARE GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2006
Last Update Date: 05/28/2024
Certification Date: 05/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37840 MEDICAL ARTS CT
ZEPHYRHILLS FL
33541-4325
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: 352-567-5455
Mailing address:
  • Phone: 352-518-2000
  • Fax: 352-567-1974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
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