Organization
PREMIER INFUSION, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CLINTONIA SIMMONS (PRESIDENT)
(901) 219-3730
Entity
Organization
Contact information
Practice address
1761 DARTFORD DR, CORDOVA, TN 38016-6497
(901) 759-0520
Mailing address
1761 DARTFORD DR, CORDOVA, TN 38016-6497
Taxonomy
Speciality
Code
Description
License number
State
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
06325305
—
MS
05
—
1454937
—
TN
Enumeration date
06/09/2006
Last updated
08/22/2020
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