Provider Demographics
NPI:1376814616
Name:PREMIER HOUSECALL PHYSICIANS LLC
Entity Type:Organization
Organization Name:PREMIER HOUSECALL PHYSICIANS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CHUKWUMA
Authorized Official - Middle Name:C
Authorized Official - Last Name:OSUAGWU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-766-1955
Mailing Address - Street 1:1015 W CENTERVILLE RD
Mailing Address - Street 2:#118
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75041-5914
Mailing Address - Country:US
Mailing Address - Phone:214-766-1955
Mailing Address - Fax:972-808-6035
Practice Address - Street 1:1015 W CENTERVILLE RD
Practice Address - Street 2:#118
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75041-5914
Practice Address - Country:US
Practice Address - Phone:214-766-1955
Practice Address - Fax:972-808-6035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-18
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM4412207R00000X
251B00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB148065OtherMEDICARE PART B
TXTXB148066Medicare PIN