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General NPI Number Information
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NPI Number | 1457639304
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Entity Type | Organization
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Legal Business Name | PREMIER TOTAL HEALTHCARE PA
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Dates
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Enumeration Date | 07/26/2011
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Last Update Date | 07/26/2011
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Provider Practice Location Address
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Address Line | 13601 PRESTON RD STE 575E
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City | DALLAS
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State | TX
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Zip | 75240-4911
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Country | US
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Telephone | 972-702-9310
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Fax | 888-767-7517
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Provider Business Mailing Address
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Address Line | PO BOX 797604
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City | DALLAS
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State | TX
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Zip | 75379-7604
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Country | US
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Telephone | 972-702-9310
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Fax | 888-767-7517
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | PATRICIA HAWKINS
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Credential |
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Telephone | 972-702-9310
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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