Provider Demographics
NPI:1437676640
Name:PREMIER INDEPENDENT PHYSICIANS GROUP, INC.
Entity Type:Organization
Organization Name:PREMIER INDEPENDENT PHYSICIANS GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-442-5209
Mailing Address - Street 1:2871 LAKE VISTA DR
Mailing Address - Street 2:SUITE 210
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067
Mailing Address - Country:US
Mailing Address - Phone:940-442-5209
Mailing Address - Fax:940-222-2720
Practice Address - Street 1:1512 TEASLEY LN
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76205-7282
Practice Address - Country:US
Practice Address - Phone:940-442-5209
Practice Address - Fax:940-222-2720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-28
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty