Healthcare Provider Details

I. General information

NPI: 1124218847
Provider Name (Legal Business Name): PREMIER FAMILY CARE I, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2007
Last Update Date: 11/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 W. WALL SUITE A
MIDLAND TX
79701-6534
US

IV. Provider business mailing address

2501 W. ILLINOIS SUITE C
MIDLAND TX
79701-6433
US

V. Phone/Fax

Practice location:
  • Phone: 432-498-2900
  • Fax: 432-498-2990
Mailing address:
  • Phone: 432-686-6600
  • Fax: 432-682-2284

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: LEAH BEJIL
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 432-686-6605