Provider Demographics
NPI:1366478802
Name:PREMIERE PHYSICIANS INC
Entity Type:Organization
Organization Name:PREMIERE PHYSICIANS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANTORIA
Authorized Official - Middle Name:HIEN
Authorized Official - Last Name:DOAN
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:623-399-6722
Mailing Address - Street 1:PO BOX 84213
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85071-4213
Mailing Address - Country:US
Mailing Address - Phone:623-476-7880
Mailing Address - Fax:623-476-7890
Practice Address - Street 1:13677 W MCDOWELL RD
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-2635
Practice Address - Country:US
Practice Address - Phone:623-476-7880
Practice Address - Fax:623-476-7890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ75962Medicare PIN
AZZ79411Medicare PIN
AZZ100088Medicare PIN
AZZ114568Medicare PIN
AZZ75667Medicare PIN
AZZ112208Medicare PIN
AZZ114480Medicare PIN
AZZ82086Medicare PIN
AZZ75592Medicare PIN
AZZ74222Medicare PIN
AZZ105778Medicare PIN