# PREMIER MEDICAL GROUP, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Premier Orthopedics, LLC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1275825432
- **Authorized official:** MRS. JUDY M MATENS (CREDENTIALLING ADMINISTRATOR)
- **Authorized official phone:** (309) 662-6200

## Contact information

- **Practice address:** 2005 JACOBSSEN DR, SUITE A, NORMAL, IL 61761-6287
- **Practice address phone:** (309) 807-2233
- **Practice address fax:** (309) 888-3174
- **Mailing address:** 2005 JACOBSSEN DR, SUITE A, NORMAL, IL 61761-6287
- **Mailing address phone:** (309) 807-2233
- **Mailing address fax:** (309) 888-3174

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | 36-098056 | IL | Yes |

## Other

- **Enumeration date:** 05/06/2011
- **Last updated:** 05/06/2011