Organization
PREMIER MEDICAL GROUP, PSC
Active
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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