Provider Demographics
NPI:1043355449
Name:PREMIER PEDIATRICS
Entity Type:Organization
Organization Name:PREMIER PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:DR
Authorized Official - First Name:KAE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCRORY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:903-247-7700
Mailing Address - Street 1:705 E MARSHALL AVE
Mailing Address - Street 2:SUITE 1002
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75601-5563
Mailing Address - Country:US
Mailing Address - Phone:903-247-7700
Mailing Address - Fax:903-238-9185
Practice Address - Street 1:705 E MARSHALL AVE
Practice Address - Street 2:SUITE 1002
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-5563
Practice Address - Country:US
Practice Address - Phone:903-247-7700
Practice Address - Fax:903-238-9185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1253208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty