Provider Demographics
NPI:1427083534
Name:PREMIER MEDICAL GROUP, PSC
Entity type:Organization
Organization Name:PREMIER MEDICAL GROUP, PSC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:BOARMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-926-2273
Mailing Address - Street 1:PO BOX 1919
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42302-1919
Mailing Address - Country:US
Mailing Address - Phone:270-926-2273
Mailing Address - Fax:270-926-5200
Practice Address - Street 1:1030 BURLEW BLVD BLDG A
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-1735
Practice Address - Country:US
Practice Address - Phone:270-926-2273
Practice Address - Fax:270-684-3212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200000370AMedicaid
KYCC5837OtherRAILROAD MEDICARE
KY000000057660OtherANTHEM BC/BS
KY65903114Medicaid
KY65903114Medicaid