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General NPI Number Information
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NPI Number | 1275549594
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Entity Type | Organization
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Legal Business Name | PREMIER HEALTH S.C.
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Dates
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Enumeration Date | 07/31/2006
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Last Update Date | 05/17/2013
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Provider Practice Location Address
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Address Line | 1540 LYON DR
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City | NEENAH
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State | WI
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Zip | 54956-5069
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Country | US
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Telephone | 920-727-4946
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Fax | 920-727-4956
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Provider Business Mailing Address
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Address Line | 1540 LYON DR
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City | NEENAH
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State | WI
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Zip | 54956-5069
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Country | US
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Telephone | 920-727-4946
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Fax | 920-727-4956
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. IFUEKO BELINDA OKUNDAYE
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Credential | M.D.
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Telephone | 920-727-4946
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 37832
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License Number State | WI
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