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Organization

PREMIER MEDICAL GROUP, PSC

Active
Other names
Physicians Affiliated Care, PSC
Organization subpart
No

Provider details

NPI number
Authorized official
MS. JENNIFER BOARMAN (BILLING MANAGER)
(270) 926-2273
Entity
Organization

Contact information

Practice address
1030 BURLEW BLVD BLDG A, OWENSBORO, KY 42303-1735
(270) 926-2273
(270) 684-3212
Mailing address
PO BOX 1919, OWENSBORO, KY 42302-1919
(270) 926-2273
(270) 926-5200

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
363A00000X
Physician Assistant
363LF0000X
Family Nurse Practitioner
363LG0600X
Gerontology Nurse Practitioner

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000057660
ANTHEM BC/BS
KY
05
200000370A
IN
05
65903114
KY
01
CC5837
RAILROAD MEDICARE
KY
Enumeration date
07/11/2006
Last updated
08/06/2021
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