Provider Demographics
NPI:1649320896
Name:PREMIER HEALTH CLINIC, LLC
Entity type:Organization
Organization Name:PREMIER HEALTH CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DICRISTOFARO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:954-582-9797
Mailing Address - Street 1:3955 N FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33064-6042
Mailing Address - Country:US
Mailing Address - Phone:954-582-9797
Mailing Address - Fax:
Practice Address - Street 1:3955 N FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33064-6042
Practice Address - Country:US
Practice Address - Phone:954-582-9797
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center