Healthcare Provider Details

I. General information

NPI: 1063151157
Provider Name (Legal Business Name): PREMIER HOSPICE PHYSICIANS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2022
Last Update Date: 05/27/2022
Certification Date: 05/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

629 RABBIT RIDGE CT
RENO NV
89511-5391
US

IV. Provider business mailing address

629 RABBIT RIDGE CT
RENO NV
89511-5391
US

V. Phone/Fax

Practice location:
  • Phone: 954-593-7739
  • Fax:
Mailing address:
  • Phone: 954-593-7739
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State

VIII. Authorized Official

Name: KENDALL QUINLAN
Title or Position: CREDENTIALING
Credential: CPCS
Phone: 775-234-2026