Provider Demographics
NPI:1043354228
Name:PREMIERE PEDIATRICS PLLC
Entity Type:Organization
Organization Name:PREMIERE PEDIATRICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BREANNA
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:WROBLEWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-928-7500
Mailing Address - Street 1:3261 24TH AVE NW STE 101
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-6666
Mailing Address - Country:US
Mailing Address - Phone:405-364-6432
Mailing Address - Fax:405-364-0090
Practice Address - Street 1:3261 24TH AVE NW STE 101
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-6666
Practice Address - Country:US
Practice Address - Phone:405-364-6432
Practice Address - Fax:405-364-0090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-19
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1700046273OtherNPI FOR DR. BRIAN T ELLIS
1780773952OtherNPI FOR GLEN DIAZ, ARNP
OKE71456Medicare UPIN
1770673600OtherNPI FOR JAMES FIELDS,MD
F04431Medicare UPIN
1972692127OtherNPI FOR EILEEN FOX, MD