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General NPI Number Information
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NPI Number | 1144405648
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Entity Type | Organization
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Legal Business Name | PREMIER MED- CARE,LLP
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Dates
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Enumeration Date | 01/02/2008
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Last Update Date | 01/02/2008
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Provider Practice Location Address
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Address Line | 724 W MAIN ST 160
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City | LEWISVILLE
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State | TX
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Zip | 75067-3514
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Country | US
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Telephone | 972-219-2300
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Fax | 972-219-2335
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Provider Business Mailing Address
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Address Line | 724 W MAIN ST 160
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City | LEWISVILLE
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State | TX
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Zip | 75067-3514
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Country | US
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Telephone | 972-219-2300
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Fax | 972-219-2335
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. ANURADHA RANGASWAMY TAVAREKERE
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Credential | M.D
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Telephone | 972-219-2300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | K9187
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License Number State | TX
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