Organization Name: | PREMIER MEDICAL GROUP, LLC |
NPI Number: | 1639468788 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JOHN HESSE (EXECUTIVE ADMINISTRATOR) |
Mailing Address: | 1505 Eastland Dr Ste 500 Bloomington |
State: | IL US |
Postal Code: | 617017905 |
Phone Number: | 3096622273 |
Fax Number: | 3096622014 |
NPI Enumeration Date: | 03/29/2011 |
NPI Last Update Date: | 03/29/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 207V00000X |
License Number: | 36-101512 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | Obstetrics & Gynecology |
Taxonomy Specialization: | |
Taxonomy Definition: | An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women. |