Provider Demographics
NPI:1831115518
Name:PREMIER WOMEN'S HEALTHCARE
Entity Type:Organization
Organization Name:PREMIER WOMEN'S HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SOLE PROPRIETER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:828-757-3301
Mailing Address - Street 1:222 MORGANTON BLVD.
Mailing Address - Street 2:
Mailing Address - City:LENOIR
Mailing Address - State:NC
Mailing Address - Zip Code:28645
Mailing Address - Country:US
Mailing Address - Phone:828-757-3301
Mailing Address - Fax:
Practice Address - Street 1:222 MORGANTON BLVD.
Practice Address - Street 2:
Practice Address - City:LENOIR
Practice Address - State:NC
Practice Address - Zip Code:28645
Practice Address - Country:US
Practice Address - Phone:828-757-3301
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200501546261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5903202Medicaid
NC5903202Medicaid
NC2334383Medicare PIN