Provider Demographics
NPI:1033752571
Name:PREMIER CARDIOLOGY CARE PLLC
Entity Type:Organization
Organization Name:PREMIER CARDIOLOGY CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HENOCK
Authorized Official - Middle Name:G
Authorized Official - Last Name:ZABHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-626-2461
Mailing Address - Street 1:2301 S FM 51 STE 400
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:TX
Mailing Address - Zip Code:76234-3864
Mailing Address - Country:US
Mailing Address - Phone:940-626-2461
Mailing Address - Fax:940-626-2462
Practice Address - Street 1:2301 S FM 51 STE 400
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:TX
Practice Address - Zip Code:76234-3864
Practice Address - Country:US
Practice Address - Phone:940-626-2461
Practice Address - Fax:940-626-2462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-28
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPENDINGMedicaid
TXH000MJ8301OtherBCBSTX