Organization Name: | PREMIER HEALTHCARE |
NPI Number: | 1174717151 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | LYNN BUSHOR (CEO) |
Mailing Address: | 160 Sayre Dr Mayfield |
State: | KY US |
Postal Code: | 420661945 |
Phone Number: | 2702473117 |
Fax Number: | |
NPI Enumeration Date: | 08/31/2007 |
NPI Last Update Date: | 08/31/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 4642P |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | KY |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |