Provider Demographics
NPI:1275549594
Name:PREMIER HEALTH S.C.
Entity Type:Organization
Organization Name:PREMIER HEALTH S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IFUEKO
Authorized Official - Middle Name:BELINDA
Authorized Official - Last Name:OKUNDAYE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:920-727-4946
Mailing Address - Street 1:1540 LYON DR
Mailing Address - Street 2:
Mailing Address - City:NEENAH
Mailing Address - State:WI
Mailing Address - Zip Code:54956-5069
Mailing Address - Country:US
Mailing Address - Phone:920-727-4946
Mailing Address - Fax:920-727-4956
Practice Address - Street 1:1540 LYON DR
Practice Address - Street 2:
Practice Address - City:NEENAH
Practice Address - State:WI
Practice Address - Zip Code:54956-5069
Practice Address - Country:US
Practice Address - Phone:920-727-4946
Practice Address - Fax:920-727-4956
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2013-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI37832261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32229200Medicaid
WIF96046Medicare UPIN