Healthcare Provider Details

I. General information

NPI: 1235280496
Provider Name (Legal Business Name): PREMIER PROVIDER HEALTH PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2007
Last Update Date: 07/06/2022
Certification Date: 07/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9301 N CENTRAL EXPY STE 340
DALLAS TX
75231-0804
US

IV. Provider business mailing address

PO BOX 3409
PFLUGERVILLE TX
78691-3409
US

V. Phone/Fax

Practice location:
  • Phone: 214-466-2828
  • Fax: 214-382-9798
Mailing address:
  • Phone: 513-252-7792
  • Fax: 513-904-5908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberM0223
License Number StateTX

VIII. Authorized Official

Name: HAN NGOC PHAM - HULEN
Title or Position: MD PA
Credential:
Phone: 214-274-1507