Provider Demographics
NPI:1629503859
Name:PREMIER INTERNAL MEDICINE AND PEDIATRICS PLLC
Entity Type:Organization
Organization Name:PREMIER INTERNAL MEDICINE AND PEDIATRICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:LOU ANTHONY
Authorized Official - Last Name:PERKINS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:731-506-6995
Mailing Address - Street 1:714 FEDERAL DR
Mailing Address - Street 2:
Mailing Address - City:SELMER
Mailing Address - State:TN
Mailing Address - Zip Code:38375-1876
Mailing Address - Country:US
Mailing Address - Phone:731-540-9083
Mailing Address - Fax:731-540-9103
Practice Address - Street 1:714 FEDERAL DR
Practice Address - Street 2:
Practice Address - City:SELMER
Practice Address - State:TN
Practice Address - Zip Code:38375-1876
Practice Address - Country:US
Practice Address - Phone:731-540-9083
Practice Address - Fax:731-540-9103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-25
Last Update Date:2017-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN46862261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care