Provider Demographics
NPI:1689897241
Name:PREMIER INTERNAL MEDICINE PC
Entity Type:Organization
Organization Name:PREMIER INTERNAL MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:828-325-0555
Mailing Address - Street 1:50 CLONINGER MILL RD NE
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-7526
Mailing Address - Country:US
Mailing Address - Phone:828-325-0555
Mailing Address - Fax:828-267-7555
Practice Address - Street 1:50 CLONINGER MILL RD NE
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-7526
Practice Address - Country:US
Practice Address - Phone:828-325-0555
Practice Address - Fax:828-267-7555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9700765207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891033WMedicaid
NC891033WMedicaid