| Premier Md | |
|
233 Forest Ct Edwardsville IL 62025-5389 | |
| (618) 510-9123 | |
| (618) 822-4095 |
| Full Name | Premier Md |
|---|---|
| Speciality | Family Medicine |
| Location | 233 Forest Ct, Edwardsville, Illinois |
| Authorized Official Name and Position | Glenn Skow (CEO) |
| Authorized Official Contact | 9175148740 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Premier Md 233 Forest Ct Edwardsville IL 62025-5389 Ph: (618) 510-9123 | Premier Md 233 Forest Ct Edwardsville IL 62025-5389 Ph: (618) 510-9123 |
| NPI Number | 1093411001 |
|---|---|
| Provider Enumeration Date | 02/01/2023 |
| Last Update Date | 02/01/2023 |
| Medicare PECOS PAC ID | 4688036205 |
|---|---|
| Medicare Enrollment ID | O20230815000391 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093411001 | NPI | - | NPPES |
| 036130323 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Glenn A Skow |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1396987053 PECOS PAC ID: 8224285135 Enrollment ID: I20120829000085 |
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