MEDICARE: PREMIER HEALTH & WELLNESS CENTER CORP

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1790643906
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIER HEALTH & WELLNESS CENTER CORP

Provider Business Mailing Address
First Line	:	2000 N FEDERAL HWY STE 201
Second Line	:
City	:	POMPANO BEACH
State	:	FL
Zip	:	33062-1022
Country	:	US
Telephone Number	:	954-235-5829
Fax Number	:

Provider Business Practice Location Address
First Line	:	2000 N FEDERAL HWY STE 201
Second Line	:
City	:	POMPANO BEACH
State	:	FL
Zip	:	33062-1022
Country	:	US
Telephone Number	:	954-235-5829
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING SPECIALIST
Name	:	MR. DARRELL JOHNSON
Credential	:
Telephone Number	:	561-356-6313

Provider Enumeration Date	:	01/14/2026
Last Update Date	:	01/14/2026

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