# PREMIERCARE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1902002116
- **Authorized official:** TIMOTHY RICHARD KRUSE MD (OWNER)
- **Authorized official phone:** (970) 927-8563

## Contact information

- **Practice address:** 227 MIDLAND AVE STE 15B, BASALT, CO 81621-8119
- **Practice address phone:** (970) 927-8563
- **Practice address fax:** (970) 927-5245
- **Mailing address:** 227 MIDLAND AVE STE 15B, BASALT, CO 81621-8119
- **Mailing address phone:** (970) 927-8563
- **Mailing address fax:** (970) 927-5245

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 06/25/2007
- **Last updated:** 08/04/2008