Provider Demographics
NPI:1053798892
Name:PREMIER HEALTHCARE
Entity type:Organization
Organization Name:PREMIER HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:S
Authorized Official - Last Name:COX
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:701-662-8662
Mailing Address - Street 1:425 COLLEGE DR S
Mailing Address - Street 2:STE #14
Mailing Address - City:DEVILS LAKE
Mailing Address - State:ND
Mailing Address - Zip Code:58301-3537
Mailing Address - Country:US
Mailing Address - Phone:701-662-8662
Mailing Address - Fax:701-662-8217
Practice Address - Street 1:425 COLLEGE DR S
Practice Address - Street 2:STE #14
Practice Address - City:DEVILS LAKE
Practice Address - State:ND
Practice Address - Zip Code:58301-3537
Practice Address - Country:US
Practice Address - Phone:701-662-8662
Practice Address - Fax:701-662-8217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-30
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care