MEDICARE: PREMIER CARE INTERNAL MEDICINE PA

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	207R00000X	Internal Medicine Physician	0432	TX

General Provider Information

NPI Number	:	1366785578
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIER CARE INTERNAL MEDICINE PA

Provider Business Mailing Address
First Line	:	3783 S LAKE FOREST DR STE 100
Second Line	:
City	:	MCKINNEY
State	:	TX
Zip	:	75070-1913
Country	:	US
Telephone Number	:	972-808-7111
Fax Number	:	972-548-7112

Provider Business Practice Location Address
First Line	:	3783 S LAKE FOREST DR STE 100
Second Line	:
City	:	MCKINNEY
State	:	TX
Zip	:	75070-1913
Country	:	US
Telephone Number	:	972-808-7111
Fax Number	:	972-548-7112

Authorized Official
Title or Position	:	PRESIDENT
Name	:	PURVI SANGHVI
Credential	:	MD
Telephone Number	:	972-808-7111

Provider Enumeration Date	:	04/05/2013
Last Update Date	:	02/15/2022

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