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General NPI Number Information
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NPI Number | 1407390800
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Entity Type | Organization
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Legal Business Name | PREMIER HEALTHCARE SERVICES
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Dates
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Enumeration Date | 12/05/2016
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Last Update Date | 12/05/2016
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Provider Practice Location Address
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Address Line | 10425 W NORTH AVE SUITE 345
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City | MILWAUKEE
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State | WI
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Zip | 53226-2416
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Country | US
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Telephone | 855-224-5810
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Fax |
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Provider Business Mailing Address
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Address Line | 10425 W NORTH AVE SUITE 345
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City | MILWAUKEE
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State | WI
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Zip | 53226-2416
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Country | US
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Telephone | 855-244-5810
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Fax |
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Authorized Official
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Title or Position | DIVISION DIRECTOR
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Name | KIMBERLY RUX
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Credential |
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Telephone | 85520245810
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | 17440000Z
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License Number State | WI
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