MEDICARE: PREMIER COMMUNITY HEALTHCARE GROUP, INC.

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	261QF0400X	Federally Qualified Health Center (FQHC)

General Provider Information

NPI Number	:	1366882573
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIER COMMUNITY HEALTHCARE GROUP, INC.

Provider Business Mailing Address
First Line	:	PO BOX 232
Second Line	:
City	:	DADE CITY
State	:	FL
Zip	:	33526-0232
Country	:	US
Telephone Number	:	352-518-2000
Fax Number	:	352-567-0218

Provider Business Practice Location Address
First Line	:	6860 MEDICAL VIEW LANE
Second Line	:
City	:	ZEPHYRHILLS
State	:	FL
Zip	:	33542-6615
Country	:	US
Telephone Number	:	352-518-2000
Fax Number	:	352-567-0218

Authorized Official
Title or Position	:	CEO
Name	:	MR. JOSEPH RESNICK
Credential	:
Telephone Number	:	352-518-2000

Provider Enumeration Date	:	07/02/2013
Last Update Date	:	06/26/2023

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