=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376272013
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PREMIUM HEALTHCARE ADVANCE INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/08/2022
-----------------------------------------------------
Last Update Date | 06/08/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10675 SW 190TH ST STE 1201
-----------------------------------------------------
City | CUTLER BAY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33157-7712
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-252-6711
-----------------------------------------------------
Fax | 786-460-8004
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10675 SW 190TH ST STE 1201
-----------------------------------------------------
City | CUTLER BAY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33157-7712
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-252-6711
-----------------------------------------------------
Fax | 786-460-8004
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | AUTHORIZED OFFICIAL
-----------------------------------------------------
Name | ANITRA CAMERON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 888-252-6711
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------