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General NPI Number Information
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NPI Number | 1821398041
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Entity Type | Organization
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Legal Business Name | PREMIER HEALTH CARE SERVIES, PLLC
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Dates
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Enumeration Date | 10/22/2010
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Last Update Date | 03/30/2011
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Provider Practice Location Address
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Address Line | 6801 W 20TH ST SUITE 208
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City | GREELEY
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State | CO
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Zip | 80634-9637
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Country | US
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Telephone | 970-330-9061
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Fax | 970-330-9064
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Provider Business Mailing Address
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Address Line | 6801 W 20TH ST SUITE 208
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City | GREELEY
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State | CO
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Zip | 80634-9637
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Country | US
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Telephone | 970-330-9061
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Fax | 970-330-9064
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KENNETH MYRON OLDS JR.
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Credential | M.D.
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Telephone | 970-330-9061
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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