Provider Demographics
NPI:1609412147
Name:PREMIER HEALTH GROUP OF FLORIDA
Entity type:Organization
Organization Name:PREMIER HEALTH GROUP OF FLORIDA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHOISETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:DAMUS
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:407-955-2324
Mailing Address - Street 1:7726 WINEGARD RD
Mailing Address - Street 2:2ND FLOOR SUITE 34
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32809-7147
Mailing Address - Country:US
Mailing Address - Phone:407-729-2050
Mailing Address - Fax:407-343-1966
Practice Address - Street 1:7726 WINEGARD RD
Practice Address - Street 2:2ND FLOOR SUITE 34
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32809-7147
Practice Address - Country:US
Practice Address - Phone:407-729-2050
Practice Address - Fax:407-343-1966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-19
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty