MEDICARE: PREMIER CLINIC LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM1300X	Multi-Specialty Clinic/Center	ME55622	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316134323
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIER CLINIC LLC

Provider Business Mailing Address
First Line	:	7807 BAYMEADOWS RD E
Second Line	:	SUITE 209
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-9666
Country	:	US
Telephone Number	:	904-565-9270
Fax Number	:	904-567-3058

Provider Business Practice Location Address
First Line	:	7807 BAYMEADOWS RD E
Second Line	:	SUITE 209
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-9666
Country	:	US
Telephone Number	:	904-565-9270
Fax Number	:	904-567-3058

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DINESH D. PATEL
Credential	:	M.D.
Telephone Number	:	904-565-9270

Provider Enumeration Date	:	10/03/2007
Last Update Date	:	02/16/2011

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Directions to “PREMIER CLINIC LLC ” Practice Location

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