MEDICARE: PREMIER TOTAL HEALTHCARE 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	208VP0000X	Pain Medicine Physician	OS5537	FL
2	111N00000X	Chiropractor	CH7202	FL
3	207Q00000X	Family Medicine Physician	OS5537	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DD8449	OTHER	FL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	45321	OTHER	FL	BC/BS OF FL GROUP#

General Provider Information

NPI Number	:	1508969536
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIER TOTAL HEALTHCARE INC

Provider Business Mailing Address
First Line	:	2415 HOLLYWOOD BLVD
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33020-6605
Country	:	US
Telephone Number	:	954-456-0250
Fax Number	:	954-456-0820

Provider Business Practice Location Address
First Line	:	2415 HOLLYWOOD BLVD
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33020-6605
Country	:	US
Telephone Number	:	954-456-0250
Fax Number	:	954-456-0820

Authorized Official
Title or Position	:	DC
Name	:	KEVIN P MCGRATH
Credential	:
Telephone Number	:	954-456-0250

Provider Enumeration Date	:	09/06/2006
Last Update Date	:	12/02/2025

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Directions to “PREMIER TOTAL HEALTHCARE INC ” Practice Location

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