Provider Demographics
NPI:1477340578
Name:PREMIUM HEALTH CENTERS
Entity type:Organization
Organization Name:PREMIUM HEALTH CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ERICK
Authorized Official - Middle Name:J
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-387-5230
Mailing Address - Street 1:2021 HERNDON AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-6317
Mailing Address - Country:US
Mailing Address - Phone:559-387-5230
Mailing Address - Fax:
Practice Address - Street 1:1415 BADGER FLAT RD
Practice Address - Street 2:
Practice Address - City:LOS BANOS
Practice Address - State:CA
Practice Address - Zip Code:93635-8600
Practice Address - Country:US
Practice Address - Phone:559-387-5230
Practice Address - Fax:559-900-7952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-22
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care