Organization
PREMIER MEDICAL GROUP, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIRILL VESSELOV (MANAGER)
(561) 556-3721
Entity
Organization
Contact information
Practice address
409 W 1ST ST, BLOOMINGTON, IN 47403-2403
(561) 556-3721
Mailing address
2925 10TH AVE N, PALM SPRINGS, FL 33461-3000
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
Other
Enumeration date
10/31/2024
Last updated
12/06/2024
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