Provider Demographics
NPI:1083195762
Name:PREMIER PEDIATRICS LLC
Entity Type:Organization
Organization Name:PREMIER PEDIATRICS LLC
Other - Org Name:PREMIER PEDIATRICS
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR, CREDENTIALING OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:EGHIGIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-273-0770
Mailing Address - Street 1:150 RICHARDSON XING
Mailing Address - Street 2:
Mailing Address - City:ARNOLD
Mailing Address - State:MO
Mailing Address - Zip Code:63010-6023
Mailing Address - Country:US
Mailing Address - Phone:314-859-4000
Mailing Address - Fax:314-859-4001
Practice Address - Street 1:5114 MID AMERICA PLZ STE 2C
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63129-0003
Practice Address - Country:US
Practice Address - Phone:314-859-4000
Practice Address - Fax:314-273-4110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-22
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty