Provider Demographics
NPI:1558763565
Name:PREMIER MEDICAL CENTER LLC
Entity Type:Organization
Organization Name:PREMIER MEDICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:HUGUET
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-262-5476
Mailing Address - Street 1:6741 CORAL WAY
Mailing Address - Street 2:STE 38
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-1762
Mailing Address - Country:US
Mailing Address - Phone:305-262-5476
Mailing Address - Fax:305-262-5520
Practice Address - Street 1:6741 CORAL WAY
Practice Address - Street 2:STE 38
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-1762
Practice Address - Country:US
Practice Address - Phone:305-262-5476
Practice Address - Fax:305-262-5520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-22
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0022712Medicare PIN
PRI-18049Medicare UPIN