Healthcare Provider Details

I. General information

NPI: 1427115187
Provider Name (Legal Business Name): PREMIER PEDIATRICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 08/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1251 NORTHFIELD RD SUITE 301
CEDAR CITY UT
84720
US

IV. Provider business mailing address

1251 NORTHFIELD RD SUITE 301
CEDAR CITY UT
84720-8916
US

V. Phone/Fax

Practice location:
  • Phone: 435-865-7227
  • Fax: 435-865-7737
Mailing address:
  • Phone: 435-865-7227
  • Fax: 435-865-7737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. ROBERT KENNETH DOWSE
Title or Position: CHAIRMAN OF THE BOARD
Credential: M.D.
Phone: 435-865-7227