Healthcare Provider Details

I. General information

NPI: 1497712103
Provider Name (Legal Business Name): PREMIER EMERGENCY PHYSICIANS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 06/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2345 DOUGHERTY FERRY RD
SAINT LOUIS MO
63122-3313
US

IV. Provider business mailing address

2345 DOUGHERTY FERRY RD
SAINT LOUIS MO
63122-3313
US

V. Phone/Fax

Practice location:
  • Phone: 314-821-5850
  • Fax: 314-966-9274
Mailing address:
  • Phone: 314-821-5850
  • Fax: 314-966-9274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number StateMO

VIII. Authorized Official

Name: MICHAEL KYLE BURTNETT
Title or Position: SVP OF OUTPATIENT SERVICES, TENET
Credential:
Phone: 469-893-2153