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General NPI Number Information
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NPI Number | 1265477582
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Entity Type | Organization
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Legal Business Name | PREMIER CENTRAL INC
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Dates
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Enumeration Date | 06/19/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2001 S MAIN ST STE 5
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City | HOPE
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State | AR
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Zip | 71801-8124
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Country | US
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Telephone | 870-722-6568
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Fax | 870-722-6353
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Provider Business Mailing Address
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Address Line | PO BOX 1387
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City | HOPE
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State | AR
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Zip | 71802-1387
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Country | US
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Telephone | 870-722-6568
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Fax | 870-722-6353
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SANDRA ANN KAEHUKAI SOOMAN
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Credential | MD
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Telephone | 870-722-6568
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | E4344
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License Number State | AR
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