Healthcare Provider Details

I. General information

NPI: 1548337942
Provider Name (Legal Business Name): PREMIER HEALTH CENTER, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 PROGRESS PKWY
SULLIVAN MO
63080-2359
US

IV. Provider business mailing address

102 PROGRESS PKWY
SULLIVAN MO
63080-2359
US

V. Phone/Fax

Practice location:
  • Phone: 573-468-6011
  • Fax: 573-468-7868
Mailing address:
  • Phone: 573-468-6011
  • Fax: 573-468-7868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number33207
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHELLE MARIA DE LA TORRE
Title or Position: ADMINISTRATOR
Credential: DC
Phone: 573-468-6011