| Premier Mobile Medical Clinic Pllc | |
|
10676 Colonial Blvd Ste 20 Fort Myers FL 33913-8715 | |
| (239) 288-7949 | |
| (239) 208-3944 |
| Full Name | Premier Mobile Medical Clinic Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 10676 Colonial Blvd Ste 20, Fort Myers, Florida |
| Authorized Official Name and Position | Nadine-anne Orinthea Singh (OWNER) |
| Authorized Official Contact | 2392887949 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Premier Mobile Medical Clinic Pllc 10676 Colonial Blvd Ste 20 Fort Myers FL 33913-8715 Ph: (239) 288-7949 | Premier Mobile Medical Clinic Pllc 10676 Colonial Blvd Ste 20 Fort Myers FL 33913-8715 Ph: (239) 288-7949 |
| NPI Number | 1386327872 |
|---|---|
| Provider Enumeration Date | 08/10/2023 |
| Last Update Date | 08/10/2023 |
| Medicare PECOS PAC ID | 7012365893 |
|---|---|
| Medicare Enrollment ID | O20231205001429 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386327872 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| 363LA2200X | Nurse Practitioner - Adult Health | (* (Not Available)) | Secondary |
| Provider Name | Brandy Rae Polanco |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386404101 PECOS PAC ID: 3173964657 Enrollment ID: I20240515001471 |
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