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General NPI Number Information
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NPI Number | 1306105655
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Entity Type | Organization
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Legal Business Name | PREMIER MEDICAL ASSOCIATES, LLC
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Dates
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Enumeration Date | 05/07/2012
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Last Update Date | 08/03/2012
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Provider Practice Location Address
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Address Line | 4050 HEALTHWAY DR SUITE 140
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City | AURORA
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State | IL
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Zip | 60504-8183
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Country | US
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Telephone | 630-318-3355
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Fax | 630-701-9277
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Provider Business Mailing Address
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Address Line | 4050 HEALTHWAY DR SUITE 140
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City | AURORA
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State | IL
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Zip | 60504-8183
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Country | US
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Telephone | 630-318-3355
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Fax | 630-701-9277
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Authorized Official
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Title or Position | OWNER
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Name | DR. ALICE MARIE RUPP
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Credential | DO
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Telephone | 630-318-3355
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 209006778
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 00303608379601
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License Number State | IL
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