Provider Demographics
NPI:1528538758
Name:PREMIER HEALTH CARE LLC
Entity Type:Organization
Organization Name:PREMIER HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:ALICIA
Authorized Official - Last Name:DOCKERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-318-5731
Mailing Address - Street 1:8023 MALCOLM RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-1717
Mailing Address - Country:US
Mailing Address - Phone:240-318-5731
Mailing Address - Fax:240-318-5850
Practice Address - Street 1:8023 MALCOLM RD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-1717
Practice Address - Country:US
Practice Address - Phone:240-318-5731
Practice Address - Fax:240-318-5850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-30
Last Update Date:2018-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD841013500Medicaid