Provider Demographics
NPI:1104205632
Name:PREMIER PEDIATRICS LLC
Entity Type:Organization
Organization Name:PREMIER PEDIATRICS LLC
Other - Org Name:PREMIER PEDIATRICS FOREST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:FARID
Authorized Official - Middle Name:
Authorized Official - Last Name:EUNUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-671-6741
Mailing Address - Street 1:7960 SW 60TH AVE
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34476-6457
Mailing Address - Country:US
Mailing Address - Phone:352-671-6741
Mailing Address - Fax:352-671-6742
Practice Address - Street 1:14141 E HIGHWAY 40 UNIT B
Practice Address - Street 2:
Practice Address - City:SILVER SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34488-3933
Practice Address - Country:US
Practice Address - Phone:352-512-0466
Practice Address - Fax:352-512-0374
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PREMIER PEDIATRICS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-05-29
Last Update Date:2015-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care