Provider Demographics
NPI:1104058593
Name:PREMIER CARE INJURY SERVICES LLC
Entity type:Organization
Organization Name:PREMIER CARE INJURY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:ROTHWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:604-599-1895
Mailing Address - Street 1:11154 HURON ST # 105-106
Mailing Address - Street 2:
Mailing Address - City:NORTHGLENN
Mailing Address - State:CO
Mailing Address - Zip Code:80234-2328
Mailing Address - Country:US
Mailing Address - Phone:303-338-1500
Mailing Address - Fax:303-338-1508
Practice Address - Street 1:11154 HURON ST # 105-106
Practice Address - Street 2:
Practice Address - City:NORTHGLENN
Practice Address - State:CO
Practice Address - Zip Code:80234-2328
Practice Address - Country:US
Practice Address - Phone:303-338-1500
Practice Address - Fax:303-338-1508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-18
Last Update Date:2009-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO37380207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC481548Medicare PIN