Provider Demographics
NPI:1417689944
Name:PREMIER WELLNESS CENTER PLLC
Entity Type:Organization
Organization Name:PREMIER WELLNESS CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:THIENDELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAGNE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-800-4378
Mailing Address - Street 1:4424 S MCCOLL RD
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-9608
Mailing Address - Country:US
Mailing Address - Phone:956-322-5292
Mailing Address - Fax:956-322-8718
Practice Address - Street 1:4424 S MCCOLL RD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-9608
Practice Address - Country:US
Practice Address - Phone:956-322-5292
Practice Address - Fax:956-322-8718
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DR. DIAGNE PREMIER OB GYN PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-06-24
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty