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Organization
PREMIERE MEDICAL GROUP PA
Active
Organization
PREMIERE MEDICAL GROUP PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MIGUEL L LORENTE M.D. (OWNER)
(321) 676-7860
Entity
Organization
Contact information
Practice address
2107 DAIRY RD, MELBOURNE, FL 32904-5209
(321) 676-7860
(321) 956-8225
Mailing address
PO BOX 120043, WEST MELBOURNE, FL 32912-0043
(321) 676-7860
(321) 952-7224
Taxonomy
Speciality
Code
Description
License number
State
282N00000X
General Acute Care Hospital
Primary
ME82880
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
262684500
—
FL
Enumeration date
10/29/2007
Last updated
10/13/2010
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