Provider Demographics
NPI:1588294300
Name:PREMIER PROVIDERS MEDCLINIC, PLLC
Entity type:Organization
Organization Name:PREMIER PROVIDERS MEDCLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SNODA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALAHMAD
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, AGPCNP-BC
Authorized Official - Phone:210-481-4455
Mailing Address - Street 1:9130 WURZBACH RD STE 102
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-1070
Mailing Address - Country:US
Mailing Address - Phone:210-481-4455
Mailing Address - Fax:210-481-4456
Practice Address - Street 1:9130 WURZBACH RD STE 102
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-1070
Practice Address - Country:US
Practice Address - Phone:210-481-4455
Practice Address - Fax:210-481-4456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-21
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty