Provider Demographics
NPI:1255803920
Name:PREMIER PEDIATRICS LLC
Entity type:Organization
Organization Name:PREMIER PEDIATRICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:KENNETH
Authorized Official - Last Name:DOWSE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:435-865-7227
Mailing Address - Street 1:1251 NORTHFIELD RD STE 301
Mailing Address - Street 2:
Mailing Address - City:CEDAR CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84721-8625
Mailing Address - Country:US
Mailing Address - Phone:435-865-7227
Mailing Address - Fax:
Practice Address - Street 1:48 S 2500 W STE 220
Practice Address - Street 2:
Practice Address - City:HURRICANE
Practice Address - State:UT
Practice Address - Zip Code:84737-3380
Practice Address - Country:US
Practice Address - Phone:435-574-9604
Practice Address - Fax:866-543-3497
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PREMIER PEDIATRICS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-12-19
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty