Provider Demographics
NPI:1669504593
Name:PREMIER PROFESSIONAL SERVICES
Entity Type:Organization
Organization Name:PREMIER PROFESSIONAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INS MGR
Authorized Official - Prefix:
Authorized Official - First Name:KEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTINO
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:800-998-9777
Mailing Address - Street 1:7200 W CAMINO REAL
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-5511
Mailing Address - Country:US
Mailing Address - Phone:800-998-9777
Mailing Address - Fax:
Practice Address - Street 1:7200 W CAMINO REAL
Practice Address - Street 2:SUITE 300
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-5511
Practice Address - Country:US
Practice Address - Phone:800-998-9777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty