Basic Information
| Provider Information | |||||||||
| NPI: | 1144718792 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PREMIER HEALTH EXPRESS AND ADVANCED DIAGNOSTICS INC | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 9710 PATUXENT WOODS DR | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210461526 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4438999525 | ||||||||
| FaxNumber: | 4432000233 | ||||||||
| Practice Location | |||||||||
| Address1: | 9710 PATUXENT WOODS DR | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210461526 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4438999525 | ||||||||
| FaxNumber: | 4432000233 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/30/2018 | ||||||||
| LastUpdateDate: | 09/17/2020 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | NOKURI | ||||||||
| AuthorizedOfficialFirstName: | SAMUEL | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4438999525 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 09/17/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QU0200X | D0070766 | MD | Y | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care |
No ID Information.