Premier Healthcare Stl Llc | |
703 Hesemann Ridge Ct Ballwin MO 63021-3602 | |
(636) 751-0362 | |
Not Available |
Full Name | Premier Healthcare Stl Llc |
---|---|
Speciality | Internal Medicine |
Location | 703 Hesemann Ridge Ct, Ballwin, Missouri |
Authorized Official Name and Position | Mohammad Amin Zaman (PRESIDENT) |
Authorized Official Contact | 6367510362 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Premier Healthcare Stl Llc 703 Hesemann Ridge Ct Wildwood MO 63021-3602 Ph: (636) 751-0362 | Premier Healthcare Stl Llc 703 Hesemann Ridge Ct Ballwin MO 63021-3602 Ph: (636) 751-0362 |
NPI Number | 1053962357 |
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Provider Enumeration Date | 09/27/2019 |
Last Update Date | 09/27/2019 |
Medicare PECOS PAC ID | 2264864685 |
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Medicare Enrollment ID | O20191030001245 |
Identifier | Type | State | Issuer |
---|---|---|---|
1053962357 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207R00000X | Internal Medicine | (* (Not Available)) | Primary |
Provider Name | Mohammad A Zaman |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1346350196 PECOS PAC ID: 6002701471 Enrollment ID: I20120120000457 |
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