Provider Demographics
NPI:1285806919
Name:PREMIER SURGICAL ASSOCIATES, PLLC
Entity type:Organization
Organization Name:PREMIER SURGICAL ASSOCIATES, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JEROME
Authorized Official - Middle Name:
Authorized Official - Last Name:ROM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-561-8900
Mailing Address - Street 1:PO BOX 52948
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37950-2948
Mailing Address - Country:US
Mailing Address - Phone:865-474-7096
Mailing Address - Fax:888-606-4409
Practice Address - Street 1:6408 PAPERMILL DR
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-4858
Practice Address - Country:US
Practice Address - Phone:865-474-7096
Practice Address - Fax:888-606-4409
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PREMIER SURGICAL ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-02
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1455291Medicaid
TN1455291Medicaid