Premier Family Physicians, P.c. | |
1150 Youngs Rd Suite 203 Williamsville NY 14221-8053 | |
(716) 688-7344 | |
(716) 688-7345 |
Full Name | Premier Family Physicians, P.c. |
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Speciality | Family Medicine |
Location | 1150 Youngs Rd, Williamsville, New York |
Authorized Official Name and Position | Nita K Divan (OWNER) |
Authorized Official Contact | 7166887344 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Premier Family Physicians, P.c. Po Box 1528 Williamsville NY 14231-1528 Ph: (716) 688-7344 | Premier Family Physicians, P.c. 1150 Youngs Rd Suite 203 Williamsville NY 14221-8053 Ph: (716) 688-7344 |
NPI Number | 1730365073 |
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Provider Enumeration Date | 01/17/2008 |
Last Update Date | 12/19/2009 |
Medicare PECOS PAC ID | 3072537398 |
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Medicare Enrollment ID | O20060125000310 |
Identifier | Type | State | Issuer |
---|---|---|---|
1730365073 | NPI | - | NPPES |
01657107 | Medicaid | NY |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |
Provider Name | Nita K Divan |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1386608339 PECOS PAC ID: 6507805306 Enrollment ID: I20050502000281 |
Provider Name | Elizabeth A Vasquez |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1245416387 PECOS PAC ID: 1052458130 Enrollment ID: I20091021000782 |
Provider Name | Ashley Iten |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1770904195 PECOS PAC ID: 4183846652 Enrollment ID: I20141118000914 |
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