Healthcare Provider Details

I. General information

NPI: 1891412029
Provider Name (Legal Business Name): PREMIER PROVIDER HEALTH PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2022
Last Update Date: 04/25/2023
Certification Date: 04/17/2023
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

1 CHISHOLM TRAIL RD STE 5200
ROUND ROCK TX
78681-5090
US

V. Phone/Fax

Practice location:
  • Phone: 214-466-2828
  • Fax: 214-382-9798
Mailing address:
  • Phone: 512-202-3830
  • Fax: 512-354-1106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

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