Provider Demographics
NPI:1477995231
Name:PREMIUM CARE MEDICAL CENTER, LLC
Entity Type:Organization
Organization Name:PREMIUM CARE MEDICAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:PRINCESS
Authorized Official - Middle Name:
Authorized Official - Last Name:DENNAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:504-361-4203
Mailing Address - Street 1:3570 HOLIDAY DR
Mailing Address - Street 2:SUITES 3-7
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70114-8287
Mailing Address - Country:US
Mailing Address - Phone:504-361-4203
Mailing Address - Fax:504-361-4204
Practice Address - Street 1:3570 HOLIDAY DR
Practice Address - Street 2:SUITES 3-7
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70114-8287
Practice Address - Country:US
Practice Address - Phone:504-361-4203
Practice Address - Fax:504-361-4204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-22
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty