Provider Demographics
NPI:1841216355
Name:PREMIER MEDICAL CARE PC
Entity Type:Organization
Organization Name:PREMIER MEDICAL CARE PC
Other - Org Name:PREMIER DIAGNOSTIC IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:C
Authorized Official - Last Name:DUNNE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:269-381-7380
Mailing Address - Street 1:1541 GULL RD
Mailing Address - Street 2:STE 100
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49048-1644
Mailing Address - Country:US
Mailing Address - Phone:269-381-7380
Mailing Address - Fax:269-341-4562
Practice Address - Street 1:1722 GULL RD
Practice Address - Street 2:SUITE 1B
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49048-1644
Practice Address - Country:US
Practice Address - Phone:269-488-5650
Practice Address - Fax:269-488-5645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4733750Medicaid
MI4733750Medicaid