Provider Demographics
NPI:1073079596
Name:PREMIER GASTROENTEROLOGY ASSOCIATES PLLC
Entity Type:Organization
Organization Name:PREMIER GASTROENTEROLOGY ASSOCIATES PLLC
Other - Org Name:PREMIER SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:GREER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-690-4424
Mailing Address - Street 1:PO BOX 26618
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72221-6601
Mailing Address - Country:US
Mailing Address - Phone:501-313-5200
Mailing Address - Fax:501-747-2868
Practice Address - Street 1:10915 RODNEY PARHAM RD
Practice Address - Street 2:SUITE A
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72212-7221
Practice Address - Country:US
Practice Address - Phone:501-747-2828
Practice Address - Fax:501-747-2868
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PREMIER GASTROENTEROLOGY ASSOCIATES PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-02-20
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty