Provider Demographics
NPI:1134181860
Name:PREMIER CARDIO PULMONARY MEDICAL INC
Entity type:Organization
Organization Name:PREMIER CARDIO PULMONARY MEDICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:JOHNS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-287-2784
Mailing Address - Street 1:PO BOX 16264
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33766-6264
Mailing Address - Country:US
Mailing Address - Phone:727-287-2784
Mailing Address - Fax:727-669-9260
Practice Address - Street 1:2194 MAIN ST
Practice Address - Street 2:SUITE I
Practice Address - City:DUNEDIN
Practice Address - State:FL
Practice Address - Zip Code:34698-5696
Practice Address - Country:US
Practice Address - Phone:727-287-2784
Practice Address - Fax:727-669-9260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-06
Last Update Date:2008-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCJ6542OtherRAILROAD MEDICARE
FLX1565OtherBCBS
FLCJ6542OtherRAILROAD MEDICARE
FLK3370Medicare PIN