Provider Demographics
NPI:1639283567
Name:PREMIER PHYSICIANS, PC
Entity Type:Organization
Organization Name:PREMIER PHYSICIANS, PC
Other - Org Name:PREMIER INFECTIOUS DISEASES, PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PHYSICIAN SECRETARY
Authorized Official - Prefix:MS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:S
Authorized Official - Last Name:TAT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:910-221-3017
Mailing Address - Street 1:1357 WALTER REED RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-4416
Mailing Address - Country:US
Mailing Address - Phone:910-221-3017
Mailing Address - Fax:910-221-3018
Practice Address - Street 1:1357 WALTER REED RD
Practice Address - Street 2:STE #102
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304
Practice Address - Country:US
Practice Address - Phone:910-221-3017
Practice Address - Fax:910-221-3018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC016CXOtherBCBS
NC89016CXMedicaid
NC89016CXMedicaid
NCDD2037Medicare PIN