Healthcare Provider Details

I. General information

NPI: 1144250960
Provider Name (Legal Business Name): PREMIERE PROVIDERS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 S PUBLIC SQ
GREENSBURG KY
42743-1533
US

IV. Provider business mailing address

112 S PUBLIC SQ
GREENSBURG KY
42743-1533
US

V. Phone/Fax

Practice location:
  • Phone: 270-932-4284
  • Fax: 270-932-4285
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number StateKY

VIII. Authorized Official

Name: MRS. RONDA LEIGH HART
Title or Position: OWNER
Credential: ARNP
Phone: 502-338-0524