Healthcare Provider Details

I. General information

NPI: 1952856353
Provider Name (Legal Business Name): PREMIER HEALTH SERVICE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2016
Last Update Date: 08/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 GWYNNS MILL CT STE F
OWINGS MILLS MD
21117-3527
US

IV. Provider business mailing address

PO BOX 1165
MIDDLETOWN DE
19709-7165
US

V. Phone/Fax

Practice location:
  • Phone: 443-213-5152
  • Fax: 302-595-3149
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: HASSAN HAYAT
Title or Position: MANAGING MEMBER
Credential:
Phone: 410-398-0590