Organization Name: | PREMIUM HEALTH SERVICES |
NPI Number: | 1275802621 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | KHAWAJA A RAHMAN (DIRECTOR) |
Mailing Address: | 6015 Rex Hall Ln Apollo Beach |
State: | FL US |
Postal Code: | 335722657 |
Phone Number: | 8136907589 |
Fax Number: | |
NPI Enumeration Date: | 12/14/2011 |
NPI Last Update Date: | 12/14/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QU0200X |
License Number: | ME79013 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Urgent Care |
Taxonomy Definition: |