Provider Demographics
NPI:1700831161
Name:PREMIER CARE PROFESSIONALS, LLC
Entity Type:Organization
Organization Name:PREMIER CARE PROFESSIONALS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:SETTEMBRINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-646-9191
Mailing Address - Street 1:111 WEBB DR
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33837-3962
Mailing Address - Country:US
Mailing Address - Phone:863-588-1424
Mailing Address - Fax:863-646-5252
Practice Address - Street 1:4725 US HIGHWAY 98 S
Practice Address - Street 2:SUITE 102
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33812-4334
Practice Address - Country:US
Practice Address - Phone:863-646-9191
Practice Address - Fax:863-646-5252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0072440261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00328830OtherRAILROAD MEDICARE
FL251631400Medicaid
FLF98907Medicare UPIN
FLK9280Medicare PIN