Provider Demographics
NPI:1508051103
Name:PREMIER MEDICAL CLINIC
Entity Type:Organization
Organization Name:PREMIER MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PARVEZ
Authorized Official - Middle Name:
Authorized Official - Last Name:KARIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:662-378-9929
Mailing Address - Street 1:PO BOX 4577
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38704-4577
Mailing Address - Country:US
Mailing Address - Phone:662-378-9929
Mailing Address - Fax:662-378-9926
Practice Address - Street 1:1504 HOSPITAL ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MS
Practice Address - Zip Code:38703-3219
Practice Address - Country:US
Practice Address - Phone:662-378-9929
Practice Address - Fax:662-378-9926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-07
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS14161207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSG00122Medicare UPIN