Provider Demographics
NPI:1730125873
Name:PREMIER COMMUNITY HEALTH CARE GROUP INC
Entity Type:Organization
Organization Name:PREMIER COMMUNITY HEALTH CARE GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:B
Authorized Official - Last Name:DELONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-567-1087
Mailing Address - Street 1:PO BOX 232
Mailing Address - Street 2:
Mailing Address - City:DODE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33526-0232
Mailing Address - Country:US
Mailing Address - Phone:352-518-2000
Mailing Address - Fax:352-567-5193
Practice Address - Street 1:14031 5TH ST
Practice Address - Street 2:
Practice Address - City:DODE CITY
Practice Address - State:FL
Practice Address - Zip Code:33525
Practice Address - Country:US
Practice Address - Phone:352-518-2000
Practice Address - Fax:352-521-3091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH212943336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy