Provider Demographics
NPI:1588121065
Name:PREMIER PEDIATRICS PLLC
Entity type:Organization
Organization Name:PREMIER PEDIATRICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:STACI
Authorized Official - Middle Name:
Authorized Official - Last Name:POLLARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-763-3050
Mailing Address - Street 1:5901 RILEY PARK DRIVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72916-9340
Mailing Address - Country:US
Mailing Address - Phone:479-763-3050
Mailing Address - Fax:479-763-3281
Practice Address - Street 1:5901 RILEY PARK DRIVE
Practice Address - Street 2:SUITE B
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72916
Practice Address - Country:US
Practice Address - Phone:479-763-3050
Practice Address - Fax:479-763-3281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-21
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARE-6232OtherARKANSAS MEDICAL LICENSE