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General NPI Number Information
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NPI Number | 1548504145
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Entity Type | Organization
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Legal Business Name | PREMIER NURSING HOME CONSULTANTS, INC
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Dates
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Enumeration Date | 11/20/2012
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Last Update Date | 11/20/2012
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Provider Practice Location Address
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Address Line | 505 GUERRANT STREET
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City | UMATILLA
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State | FL
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Zip | 32784-2468
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Country | US
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Telephone | 352-669-4159
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Fax |
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Provider Business Mailing Address
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Address Line | P.O. BOX 2468
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City | UATILLA
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State | FL
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Zip | 32784-2468
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Country | US
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Telephone | 352-669-4159
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Fax |
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | LOUIS J RADNOTHY
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Credential | D.O.
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Telephone | 352-669-4159
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | OS4452
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License Number State | FL
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