Provider Demographics
NPI:1700032745
Name:PREMIER PROVIDER HEALTH PA
Entity Type:Organization
Organization Name:PREMIER PROVIDER HEALTH PA
Other - Org Name:HAN PHAM HULEN, MD PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HAN
Authorized Official - Middle Name:PHAM
Authorized Official - Last Name:HULEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-945-7313
Mailing Address - Street 1:1 CHISHOLM TRAIL RD STE 5200
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-5090
Mailing Address - Country:US
Mailing Address - Phone:512-202-3830
Mailing Address - Fax:512-354-1106
Practice Address - Street 1:9301 N CENTRAL EXPY STE 340
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-0804
Practice Address - Country:US
Practice Address - Phone:214-466-2828
Practice Address - Fax:214-382-9798
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-11
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00X633OtherMEDICARE
TX511609OtherMEDICARE
TX771927OtherMEDICARE
TX0A0069OtherMEDICARE
TX540842OtherMEDICARE