| Premier Psych Llc | |
|
1580 Santa Barbara Blvd The Villages FL 32159-6827 | |
| (352) 259-2159 | |
| Not Available |
| Full Name | Premier Psych Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 1580 Santa Barbara Blvd, The Villages, Florida |
| Authorized Official Name and Position | Cynthia Romska (AUTHORIZED OFFICIAL) |
| Authorized Official Contact | 3523534212 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Premier Psych Llc 1580 Santa Barbara Blvd The Villages FL 32159-6827 Ph: (352) 259-2159 | Premier Psych Llc 1580 Santa Barbara Blvd The Villages FL 32159-6827 Ph: (352) 259-2159 |
| NPI Number | 1083246441 |
|---|---|
| Provider Enumeration Date | 02/04/2020 |
| Last Update Date | 02/10/2020 |
| Certification Date | 02/10/2020 |
| Medicare PECOS PAC ID | 6204263296 |
|---|---|
| Medicare Enrollment ID | O20200304001696 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083246441 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Kenneth Ethan Lai |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1376893974 PECOS PAC ID: 8325266489 Enrollment ID: I20151201001118 |
| Provider Name | John Samaan |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1225325988 PECOS PAC ID: 9133413164 Enrollment ID: I20231220003576 |
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