Healthcare Provider Details

I. General information

NPI: 1538579347
Provider Name (Legal Business Name): PREMIER PHC PHYSICIAN GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2014
Last Update Date: 07/25/2025
Certification Date: 07/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1820 N LAKE FOREST DR STE 300B
MCKINNEY TX
75071-7653
US

IV. Provider business mailing address

1512 TEASLEY LN
DENTON TX
76205-7282
US

V. Phone/Fax

Practice location:
  • Phone: 469-631-0935
  • Fax: 214-216-0435
Mailing address:
  • Phone: 940-442-5209
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberQ4003
License Number StateTX

VIII. Authorized Official

Name: CAROL NGUYEN
Title or Position: CHIEF NURSING OFFICER
Credential:
Phone: 940-442-5209