Provider Demographics
NPI:1285689117
Name:PREMIER MEDICAL DOCTORS INC.
Entity Type:Organization
Organization Name:PREMIER MEDICAL DOCTORS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTILLANES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-717-8285
Mailing Address - Street 1:12523 LIMONITE AVE
Mailing Address - Street 2:SUITE 440-235
Mailing Address - City:MIRA LOMA
Mailing Address - State:CA
Mailing Address - Zip Code:91752-3665
Mailing Address - Country:US
Mailing Address - Phone:714-717-8285
Mailing Address - Fax:951-685-3381
Practice Address - Street 1:115 W E ST
Practice Address - Street 2:
Practice Address - City:TEHACHAPI
Practice Address - State:CA
Practice Address - Zip Code:93561-1607
Practice Address - Country:US
Practice Address - Phone:714-717-8285
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA37580Medicare UPIN
CAI37817Medicare UPIN
CAE99338Medicare UPIN
CAI31165Medicare UPIN
CAF08842Medicare UPIN
CAA28663Medicare UPIN
CAD34066Medicare UPIN
CAH76721Medicare UPIN