Provider Demographics
NPI:1043821218
Name:PREMIER CARDIOVASCULAR CARE & WELLNESS
Entity type:Organization
Organization Name:PREMIER CARDIOVASCULAR CARE & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TREVINA
Authorized Official - Middle Name:R
Authorized Official - Last Name:WASHINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-635-6071
Mailing Address - Street 1:3440 TORINGDON WAY STE 205
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-3191
Mailing Address - Country:US
Mailing Address - Phone:704-635-6071
Mailing Address - Fax:980-221-1956
Practice Address - Street 1:4707 SOUTH BLVD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28217-2117
Practice Address - Country:US
Practice Address - Phone:704-635-6071
Practice Address - Fax:855-655-3374
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PREMIER CARDIOVASCULAR CARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-08-12
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty