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General NPI Number Information
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NPI Number | 1588294300
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Entity Type | Organization
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Legal Business Name | PREMIER PROVIDERS MEDCLINIC, PLLC
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Dates
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Enumeration Date | 01/21/2020
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Last Update Date | 09/23/2020
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Provider Practice Location Address
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Address Line | 9130 WURZBACH RD STE 102
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City | SAN ANTONIO
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State | TX
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Zip | 78240-1070
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Country | US
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Telephone | 210-481-4455
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Fax | 210-481-4456
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Provider Business Mailing Address
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Address Line | 9130 WURZBACH RD STE 102
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City | SAN ANTONIO
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State | TX
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Zip | 78240-1070
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Country | US
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Telephone | 210-481-4455
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Fax | 210-481-4456
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Authorized Official
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Title or Position | OWNER
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Name | SNODA ALAHMAD
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Credential | DNP, AGPCNP-BC
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Telephone | 210-481-4455
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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