Provider Demographics
NPI:1407390800
Name:PREMIER HEALTHCARE SERVICES
Entity Type:Organization
Organization Name:PREMIER HEALTHCARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIVISION DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:RUX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:8552-024-5810
Mailing Address - Street 1:10425 W NORTH AVE
Mailing Address - Street 2:SUITE 345
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-2416
Mailing Address - Country:US
Mailing Address - Phone:855-244-5810
Mailing Address - Fax:
Practice Address - Street 1:10425 W NORTH AVE
Practice Address - Street 2:SUITE 345
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-2416
Practice Address - Country:US
Practice Address - Phone:855-224-5810
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PREMIER FINANCIAL MANAGEMENT SERVICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-12-05
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI17440000Z305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization