Provider Demographics
NPI:1356533954
Name:PREMIER MEDICAL CENTRE, LLC
Entity type:Organization
Organization Name:PREMIER MEDICAL CENTRE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PEARLINE
Authorized Official - Middle Name:M
Authorized Official - Last Name:BUTCHER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:615-690-4293
Mailing Address - Street 1:341 WALLACE RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-8000
Mailing Address - Country:US
Mailing Address - Phone:615-690-4293
Mailing Address - Fax:
Practice Address - Street 1:341 WALLACE RD
Practice Address - Street 2:SUITE B
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-8000
Practice Address - Country:US
Practice Address - Phone:615-690-4293
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-16
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDO0000000697207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNC67808Medicare UPIN
TN3031270Medicare PIN