Basic Information
| Provider Information | |||||||||
| NPI: | 1669805461 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PREMIER HEALTHCARE CONSULTANTS OF TAMPA BAY, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8210 SW 163RD PL | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331935104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3053234661 | ||||||||
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| Practice Location | |||||||||
| Address1: | 13055 SW 42ND ST | ||||||||
| Address2: | SUITE 108 | ||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331753406 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3053234661 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2013 | ||||||||
| LastUpdateDate: | 08/15/2013 | ||||||||
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| AuthorizedOfficialLastName: | GOMEZ | ||||||||
| AuthorizedOfficialFirstName: | JULIE | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3053234661 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | ARNP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | Y | Ambulatory Health Care Facilities | Clinic/Center |
No ID Information.