Provider Demographics
NPI:1588077242
Name:PREMIER SURGICAL SPECIALISTS PC
Entity type:Organization
Organization Name:PREMIER SURGICAL SPECIALISTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SAMAR
Authorized Official - Middle Name:B
Authorized Official - Last Name:SHABEEB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-836-9800
Mailing Address - Street 1:9050 COLUMBIA AVE
Mailing Address - Street 2:PREMIER SURGICAL SPECIALISTS PC
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-2905
Mailing Address - Country:US
Mailing Address - Phone:219-836-9800
Mailing Address - Fax:219-836-9300
Practice Address - Street 1:9050 COLUMBIA AVE
Practice Address - Street 2:PREMIER SURGICAL SPECIALISTS PC
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-2905
Practice Address - Country:US
Practice Address - Phone:219-836-9800
Practice Address - Fax:219-836-9300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-10
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty