Organization
PREMIER COMMUNITY HEALTHCARE GROUP INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER MAFFETT (HEALTH DATA ANALYST)
(352) 518-2000
Entity
Organization
Contact information
Practice address
14027 5TH ST, DADE CITY, FL 33525-4302
(352) 518-2000
(352) 567-0218
Mailing address
PO BOX 232, DADE CITY, FL 33526-0232
(352) 518-2000
(352) 567-1974
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
029550700
—
FL
Enumeration date
02/07/2006
Last updated
10/09/2019
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