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General NPI Number Information
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NPI Number | 1992147706
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Entity Type | Organization
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Legal Business Name | PREMIUM HEALTH CARE SERVICES
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Dates
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Enumeration Date | 07/22/2013
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Last Update Date | 07/22/2013
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Provider Practice Location Address
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Address Line | 21436 N 20TH AVE STE 211
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City | PHOENIX
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State | AZ
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Zip | 85027-2612
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Country | US
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Telephone | 602-329-8962
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Fax | 623-582-4893
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Provider Business Mailing Address
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Address Line | 21436 N 20TH AVE STE 211
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City | PHOENIX
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State | AZ
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Zip | 85027-2612
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Country | US
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Telephone | 602-329-8962
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Fax | 623-582-4893
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Authorized Official
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Title or Position | OWNER
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Name | MR. LARRY JUNIOR ALEXANDER
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Credential |
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Telephone | 602-329-4623
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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