Organization
PREMIER PHYSICAL MEDICINE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TANNER P HANCOCK (OWNER)
(316) 683-9500
Entity
Organization
Contact information
Practice address
3011 N UNION ST, PONCA CITY, OK 74601-7400
(316) 683-9500
(316) 683-9502
Mailing address
6224 SHADYBROOK ST, WICHITA, KS 67208-1844
(316) 683-9500
(316) 683-9502
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
KS
Other
Enumeration date
03/27/2013
Last updated
03/27/2013
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