Provider Demographics
NPI:1629811740
Name:PREMIER HEALTH SERVICES SOUTH FLORIDA
Entity type:Organization
Organization Name:PREMIER HEALTH SERVICES SOUTH FLORIDA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:HEVERT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-789-8855
Mailing Address - Street 1:170 NE 2ND ST UNIT 1139
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33429-5050
Mailing Address - Country:US
Mailing Address - Phone:561-715-1051
Mailing Address - Fax:671-395-6891
Practice Address - Street 1:800 MEADOWS RD
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-2304
Practice Address - Country:US
Practice Address - Phone:561-715-1051
Practice Address - Fax:561-395-6891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-17
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty