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General NPI Number Information
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NPI Number | 1558102228
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Entity Type | Organization
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Legal Business Name | PREMIER FAMILY HEALTH CARE LLC
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Dates
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Enumeration Date | 06/05/2024
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Last Update Date | 12/06/2024
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Provider Practice Location Address
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Address Line | 310 N PROGRESS AVE
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City | SILOAM SPRINGS
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State | AR
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Zip | 72761-4093
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Country | US
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Telephone | 479-225-5429
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Fax |
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Provider Business Mailing Address
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Address Line | 11005 N WEDINGTON BLACKTOP RD
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City | LINCOLN
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State | AR
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Zip | 72744-9459
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | TRACEY MOORE
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Credential |
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Telephone | 479-225-5429
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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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 | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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