Provider Demographics
NPI:1265477582
Name:PREMIER CENTRAL INC
Entity Type:Organization
Organization Name:PREMIER CENTRAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDRA ANN
Authorized Official - Middle Name:KAEHUKAI
Authorized Official - Last Name:SOOMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:870-722-6568
Mailing Address - Street 1:PO BOX 1387
Mailing Address - Street 2:
Mailing Address - City:HOPE
Mailing Address - State:AR
Mailing Address - Zip Code:71802-1387
Mailing Address - Country:US
Mailing Address - Phone:870-722-6568
Mailing Address - Fax:870-722-6353
Practice Address - Street 1:2001 S MAIN ST
Practice Address - Street 2:STE 5
Practice Address - City:HOPE
Practice Address - State:AR
Practice Address - Zip Code:71801-8124
Practice Address - Country:US
Practice Address - Phone:870-722-6568
Practice Address - Fax:870-722-6353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE4344208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty