Provider Demographics
NPI:1649045832
Name:PREMIER ALLERGIST OF FLORIDA LLC
Entity type:Organization
Organization Name:PREMIER ALLERGIST OF FLORIDA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP RCM
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ALTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-209-8355
Mailing Address - Street 1:4975 PRESTON PARK BLVD STE 800
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-5152
Mailing Address - Country:US
Mailing Address - Phone:469-209-8355
Mailing Address - Fax:
Practice Address - Street 1:785 W GRANADA BLVD STE 4
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-5163
Practice Address - Country:US
Practice Address - Phone:386-673-1323
Practice Address - Fax:386-676-7448
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PREMIER ALLERGIST OF FLORIDA LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-11-17
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty