Provider Demographics
NPI:1861664724
Name:PREMIER PEDIATRICS LLC
Entity Type:Organization
Organization Name:PREMIER PEDIATRICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:MS
Authorized Official - First Name:VIVIENNE
Authorized Official - Middle Name:CAROL
Authorized Official - Last Name:MEANGER
Authorized Official - Suffix:
Authorized Official - Credentials:MHS, OTR/L
Authorized Official - Phone:520-977-8924
Mailing Address - Street 1:7803 E. MARQUISE DRIVE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85715-3773
Mailing Address - Country:US
Mailing Address - Phone:520-977-8924
Mailing Address - Fax:520-721-4948
Practice Address - Street 1:7803 E MARQUISE DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85715-3773
Practice Address - Country:US
Practice Address - Phone:520-977-8924
Practice Address - Fax:520-742-2082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-31
Last Update Date:2009-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2363225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty