Provider Demographics
NPI:1093829442
Name:PREMIER MEDICAL ASSOCIATES ALL FLORIDA, LLC
Entity Type:Organization
Organization Name:PREMIER MEDICAL ASSOCIATES ALL FLORIDA, LLC
Other - Org Name:PREMIER MEDICAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROMSKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-259-2159
Mailing Address - Street 1:1580 SANTA BARBARA BLVD
Mailing Address - Street 2:
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32159-6827
Mailing Address - Country:US
Mailing Address - Phone:352-259-2159
Mailing Address - Fax:352-674-4386
Practice Address - Street 1:1580 SANTA BARBARA BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32159
Practice Address - Country:US
Practice Address - Phone:352-259-2159
Practice Address - Fax:352-259-5731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0069935207R00000X
FLME95629207RN0300X
FLARNP3378652363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004699000Medicaid
FLK3300OtherPTAN