Provider Demographics
NPI:1336814532
Name:PREMIER ASSOCIATES FOR THE HEALTHCARE OF WOMEN LLC
Entity Type:Organization
Organization Name:PREMIER ASSOCIATES FOR THE HEALTHCARE OF WOMEN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RUEL
Authorized Official - Middle Name:TYRONE
Authorized Official - Last Name:STOESSEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-630-8001
Mailing Address - Street 1:8645 N MILITARY TRL STE 508
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33410-6296
Mailing Address - Country:US
Mailing Address - Phone:561-630-8001
Mailing Address - Fax:561-630-8007
Practice Address - Street 1:1405 SE GOLDTREE DR STE D
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-7563
Practice Address - Country:US
Practice Address - Phone:772-800-7000
Practice Address - Fax:772-878-1276
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PREMIER ASSOCIATES FOR THE HEALTHCARE OF WOMEN,LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-08-10
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty