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General NPI Number Information
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NPI Number | 1790239762
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Entity Type | Organization
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Legal Business Name | PREMIER MEDICAL CNTR OF HUMACAO LLC
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Dates
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Enumeration Date | 08/08/2016
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | AVE. BOULEVARD SUR, TORRE PISO 1 BOULEVARD DEL RIO OFFICE CENTER, BO. RIO ABAJO
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City | HUMACAO
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State | PR
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Zip | 00791-0000
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Country | US
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Telephone | 787-656-2727
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Fax | 787-656-2732
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Provider Business Mailing Address
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Address Line | 10319 JEFFERSON HWY
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City | BATON ROUGE
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State | LA
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Zip | 70809-2730
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Country | US
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Telephone | 225-214-9352
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Fax | 225-214-9349
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Authorized Official
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Title or Position | VP, REV. CYCLE SERVICES
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Name | MS. TAMARA B WHITE
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Credential |
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Telephone | 225-239-7190
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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