=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093965501
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PREMIER HOSPITALIST PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/22/2008
-----------------------------------------------------
Last Update Date | 09/30/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 600 GRANT ST
-----------------------------------------------------
City | GARY
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46402-6001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-288-3452
-----------------------------------------------------
Fax | 708-401-0050
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1047
-----------------------------------------------------
City | CROWN POINT
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46308-1047
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-288-3452
-----------------------------------------------------
Fax | 708-401-0050
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN/OWNER
-----------------------------------------------------
Name | EMERIC PALMER
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 708-288-3452
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208M00000X
-----------------------------------------------------
Taxonomy Name | Hospitalist Physician
-----------------------------------------------------
License Number | 01049154
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 01049154
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------