Provider Demographics
NPI:1235280496
Name:PREMIER PROVIDER HEALTH PA
Entity Type:Organization
Organization Name:PREMIER PROVIDER HEALTH PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD PA
Authorized Official - Prefix:
Authorized Official - First Name:HAN
Authorized Official - Middle Name:NGOC
Authorized Official - Last Name:PHAM - HULEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-274-1507
Mailing Address - Street 1:PO BOX 3409
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78691-3409
Mailing Address - Country:US
Mailing Address - Phone:513-252-7792
Mailing Address - Fax:513-904-5908
Practice Address - Street 1:9301 N CENTRAL EXPY STE 340
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-0804
Practice Address - Country:US
Practice Address - Phone:214-466-2828
Practice Address - Fax:214-382-9798
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-15
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM0223207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0021NBOtherBCBS
TXDG0245OtherRR MEDICARE
TX00X633Medicare PIN