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General NPI Number Information
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NPI Number | 1699073486
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Entity Type | Organization
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Legal Business Name | PREMIER HOSPITALIST GROUP LLC
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Dates
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Enumeration Date | 03/03/2011
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Last Update Date | 05/01/2012
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Provider Practice Location Address
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Address Line | 1301 1ST ST
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City | KENNETT
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State | MO
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Zip | 63857-2525
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Country | US
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Telephone | 573-332-0052
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Fax | 573-332-0007
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Provider Business Mailing Address
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Address Line | 2909 INDEPENDENCE STREET
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City | CAPE GIRARDEAU
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State | MO
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Zip | 63703-5044
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Country | US
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Telephone | 573-332-0052
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Fax | 573-332-0007
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. VISHNU SUBRAMANI
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Credential | M.D.
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Telephone | 573-332-0052
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 2005005184
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License Number State | MO
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