Provider Demographics
NPI:1487196150
Name:PREMIER PEDIATRIC HEALTHCARE SERVICES
Entity Type:Organization
Organization Name:PREMIER PEDIATRIC HEALTHCARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:GRETCHEN
Authorized Official - Last Name:HOLLOWAY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:662-934-0206
Mailing Address - Street 1:287 GREEN OAK LN
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-8213
Mailing Address - Country:US
Mailing Address - Phone:662-934-0206
Mailing Address - Fax:
Practice Address - Street 1:287 GREEN OAK LN
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-8213
Practice Address - Country:US
Practice Address - Phone:662-934-0206
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-13
Last Update Date:2016-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care