Provider Demographics
NPI:1295953842
Name:PREMIER INTERNISTS S.C.
Entity type:Organization
Organization Name:PREMIER INTERNISTS S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CICILY
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:630-355-4755
Mailing Address - Street 1:620 N RIVER RD
Mailing Address - Street 2:STE 102
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-8950
Mailing Address - Country:US
Mailing Address - Phone:630-355-4755
Mailing Address - Fax:630-355-8838
Practice Address - Street 1:620 N RIVER RD
Practice Address - Street 2:STE 102
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-8950
Practice Address - Country:US
Practice Address - Phone:630-355-4755
Practice Address - Fax:630-355-8838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
211302Medicare UPIN