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General NPI Number Information
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NPI Number | 1427083534
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Entity Type | Organization
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Legal Business Name | PREMIER MEDICAL GROUP, PSC
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Dates
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Enumeration Date | 07/11/2006
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Last Update Date | 08/06/2021
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Provider Practice Location Address
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Address Line | 1030 BURLEW BLVD BLDG A
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City | OWENSBORO
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State | KY
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Zip | 42303-1735
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Country | US
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Telephone | 270-926-2273
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Fax | 270-684-3212
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Provider Business Mailing Address
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Address Line | PO BOX 1919
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City | OWENSBORO
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State | KY
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Zip | 42302-1919
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Country | US
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Telephone | 270-926-2273
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Fax | 270-926-5200
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | MS. JENNIFER BOARMAN
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Credential |
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Telephone | 270-926-2273
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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