Provider Demographics
NPI:1003140724
Name:PREMIUM SUPPORT SERVICES INC
Entity Type:Organization
Organization Name:PREMIUM SUPPORT SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:RUMORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-284-0337
Mailing Address - Street 1:6568 S FEDERAL WAY
Mailing Address - Street 2:STE 311
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83716-9277
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6568 S FEDERAL WAY
Practice Address - Street 2:STE 311
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83716-9277
Practice Address - Country:US
Practice Address - Phone:208-284-0337
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-28
Last Update Date:2009-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM5928207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty