Provider Demographics
NPI:1124721410
Name:PREMIERE PEDIATRICS PLLC
Entity type:Organization
Organization Name:PREMIERE PEDIATRICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:JAYNE
Authorized Official - Last Name:ROWORTH-CHAIKIN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:903-315-3966
Mailing Address - Street 1:703 E MARSHALL AVE STE 4002
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75601-5622
Mailing Address - Country:US
Mailing Address - Phone:903-315-3966
Mailing Address - Fax:903-230-0795
Practice Address - Street 1:703 E MARSHALL AVE STE 4002
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-5622
Practice Address - Country:US
Practice Address - Phone:903-315-3966
Practice Address - Fax:903-230-0795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-24
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty