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General NPI Number Information
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NPI Number | 1710315726
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Entity Type | Organization
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Legal Business Name | PREMIER ER SERVICES, LLC
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Dates
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Enumeration Date | 10/30/2013
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Last Update Date | 11/13/2013
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Provider Practice Location Address
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Address Line | 1867 N BISSELL ST UNIT #1A
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City | CHICAGO
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State | IL
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Zip | 60614-5012
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Country | US
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Telephone | 317-213-9890
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Fax |
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Provider Business Mailing Address
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Address Line | 1867 N BISSELL ST UNIT #1A
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City | CHICAGO
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State | IL
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Zip | 60614-5012
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Country | US
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Telephone | 317-213-9890
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DAVID NGUYEN
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Credential | D.O.
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Telephone | 317-213-9890
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 036.132627
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License Number State | IL
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