Healthcare Provider Details

I. General information

NPI: 1710315726
Provider Name (Legal Business Name): PREMIER ER SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2013
Last Update Date: 11/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1867 N BISSELL ST UNIT #1A
CHICAGO IL
60614-5012
US

IV. Provider business mailing address

1867 N BISSELL ST UNIT #1A
CHICAGO IL
60614-5012
US

V. Phone/Fax

Practice location:
  • Phone: 317-213-9890
  • Fax:
Mailing address:
  • Phone: 317-213-9890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number036.132627
License Number StateIL

VIII. Authorized Official

Name: DAVID NGUYEN
Title or Position: MANAGER
Credential: D.O.
Phone: 317-213-9890