Healthcare Provider Details

I. General information

NPI: 1427083534
Provider Name (Legal Business Name): PREMIER MEDICAL GROUP, PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 08/06/2021
Certification Date: 08/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 BURLEW BLVD BLDG A
OWENSBORO KY
42303-1735
US

IV. Provider business mailing address

PO BOX 1919
OWENSBORO KY
42302-1919
US

V. Phone/Fax

Practice location:
  • Phone: 270-926-2273
  • Fax: 270-684-3212
Mailing address:
  • Phone: 270-926-2273
  • Fax: 270-926-5200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. JENNIFER BOARMAN
Title or Position: BILLING MANAGER
Credential:
Phone: 270-926-2273