Provider Demographics
NPI:1871942938
Name:PREMIER ER PLUS - WACO, LLC
Entity type:Organization
Organization Name:PREMIER ER PLUS - WACO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:POOL
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:254-224-8808
Mailing Address - Street 1:900 AUSTIN AVE
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76701-1902
Mailing Address - Country:US
Mailing Address - Phone:254-224-8808
Mailing Address - Fax:254-224-6590
Practice Address - Street 1:221 N JACK KULTGEN EXPY
Practice Address - Street 2:SUITE 100
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76706
Practice Address - Country:US
Practice Address - Phone:254-224-8808
Practice Address - Fax:254-224-6590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-09
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care