Provider Demographics
NPI:1245895333
Name:PREMIER HOSPITALIST GROUP PLLC
Entity type:Organization
Organization Name:PREMIER HOSPITALIST GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:
Authorized Official - First Name:KHUZEMA
Authorized Official - Middle Name:
Authorized Official - Last Name:KANCHWALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-467-1114
Mailing Address - Street 1:16709 HIGHLINE BLVD
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77306-6045
Mailing Address - Country:US
Mailing Address - Phone:936-443-7808
Mailing Address - Fax:
Practice Address - Street 1:22999 HIGHWAY 59 N
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-4412
Practice Address - Country:US
Practice Address - Phone:936-443-7408
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-05
Last Update Date:2019-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty