Provider Demographics
NPI:1194434662
Name:PREMIUM HEALTHCARE HOLDINGS, LLLP
Entity type:Organization
Organization Name:PREMIUM HEALTHCARE HOLDINGS, LLLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEILA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOOVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-265-4441
Mailing Address - Street 1:2400 SW 69TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-2919
Mailing Address - Country:US
Mailing Address - Phone:305-265-4441
Mailing Address - Fax:
Practice Address - Street 1:12905 SW 42ND ST STE 106
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-2910
Practice Address - Country:US
Practice Address - Phone:305-229-2020
Practice Address - Fax:305-229-2218
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PREMIUM HEALTHCARE HOLDINGS, LLLP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-11-23
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty