Provider Demographics
NPI:1023575495
Name:PREMIERMD SIM, LLC
Entity Type:Organization
Organization Name:PREMIERMD SIM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:TOLEDANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-561-5135
Mailing Address - Street 1:3465 GALT OCEAN DR STE 203
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-7077
Mailing Address - Country:US
Mailing Address - Phone:954-561-5135
Mailing Address - Fax:954-566-9997
Practice Address - Street 1:3465 GALT OCEAN DR STE 203
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-7077
Practice Address - Country:US
Practice Address - Phone:954-561-5135
Practice Address - Fax:954-566-9997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-21
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization