Healthcare Provider Details

I. General information

NPI: 1306369442
Provider Name (Legal Business Name): PREMIER MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2017
Last Update Date: 03/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 SAINT ROSE PKWY
HENDERSON NV
89052-3839
US

IV. Provider business mailing address

2660 CRIMSON CANYON DR STE 130
LAS VEGAS NV
89128-0846
US

V. Phone/Fax

Practice location:
  • Phone: 702-453-3799
  • Fax: 702-453-5741
Mailing address:
  • Phone: 702-453-3799
  • Fax: 702-453-5741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number11791
License Number StateNV

VIII. Authorized Official

Name: ANANT K SONPATKI
Title or Position: OWNER / PROVIDER
Credential: M.D.
Phone: 503-449-8752