Provider Demographics
NPI:1790239762
Name:PREMIER MEDICAL CNTR OF HUMACAO LLC
Entity Type:Organization
Organization Name:PREMIER MEDICAL CNTR OF HUMACAO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP, REV. CYCLE SERVICES
Authorized Official - Prefix:MS
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:B
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-239-7190
Mailing Address - Street 1:10319 JEFFERSON HWY
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-2730
Mailing Address - Country:US
Mailing Address - Phone:225-214-9352
Mailing Address - Fax:225-214-9349
Practice Address - Street 1:AVE. BOULEVARD SUR, TORRE PISO 1
Practice Address - Street 2:BOULEVARD DEL RIO OFFICE CENTER, BO. RIO ABAJO
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791-0000
Practice Address - Country:US
Practice Address - Phone:787-656-2727
Practice Address - Fax:787-656-2732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center