Basic Information
| Provider Information | |||||||||
| NPI: | 1811200538 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PREMIER SURGICAL ASSOCIATES INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1280 E LATHAM AVE | ||||||||
| Address2: | |||||||||
| City: | HEMET | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925434445 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9517661222 | ||||||||
| FaxNumber: | 9517661226 | ||||||||
| Practice Location | |||||||||
| Address1: | 1280 E LATHAM AVE | ||||||||
| Address2: | |||||||||
| City: | HEMET | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925434445 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9517661222 | ||||||||
| FaxNumber: | 9517661226 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/22/2010 | ||||||||
| LastUpdateDate: | 08/10/2010 | ||||||||
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| AuthorizedOfficialLastName: | JOHNSON | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9517661222 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | A88275 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.