Provider Demographics
NPI:1508574641
Name:PREMIUM HEALTHCARE HOLDINGS, LLLP
Entity Type:Organization
Organization Name:PREMIUM HEALTHCARE HOLDINGS, LLLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEILA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOOVER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-265-4441
Mailing Address - Street 1:2400 SW 69TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-2919
Mailing Address - Country:US
Mailing Address - Phone:305-265-4441
Mailing Address - Fax:
Practice Address - Street 1:6963 SW 117TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-2803
Practice Address - Country:US
Practice Address - Phone:305-265-4441
Practice Address - Fax:305-265-4844
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PREMIUM HEALTHCARE HOLDINGS, LLLP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-11-08
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center