Basic Information
| Provider Information | |||||||||
| NPI: | 1245249655 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PREMIER FAMILY HEALTH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1037 S STATE ROAD 7 | ||||||||
| Address2: | SUITE 211 | ||||||||
| City: | WELLINGTON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334146138 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5617983030 | ||||||||
| FaxNumber: | 5617988242 | ||||||||
| Practice Location | |||||||||
| Address1: | 1037 S STATE ROAD 7 | ||||||||
| Address2: | SUITE 211 | ||||||||
| City: | WELLINGTON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334146138 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5617983030 | ||||||||
| FaxNumber: | 5617988242 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/05/2006 | ||||||||
| LastUpdateDate: | 05/27/2008 | ||||||||
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| AuthorizedOfficialLastName: | APICELLA | ||||||||
| AuthorizedOfficialFirstName: | VINCENT | ||||||||
| AuthorizedOfficialMiddleName: | MICHAEL | ||||||||
| AuthorizedOfficialTitleorPosition: | DOCTOR | ||||||||
| AuthorizedOfficialTelephone: | 5617983030 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | D.O. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | OS8748 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.