Provider Demographics
NPI:1912705484
Name:PREMIER PSYCHIATRIC PROVIDERS CORPORATION
Entity type:Organization
Organization Name:PREMIER PSYCHIATRIC PROVIDERS CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:EVAN
Authorized Official - Last Name:MANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-999-0559
Mailing Address - Street 1:20 MEADOWBROOK LN
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:MA
Mailing Address - Zip Code:01069-1134
Mailing Address - Country:US
Mailing Address - Phone:941-999-0559
Mailing Address - Fax:833-227-3180
Practice Address - Street 1:935 N. BENEVA ROAD STE 609
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34232
Practice Address - Country:US
Practice Address - Phone:941-999-0559
Practice Address - Fax:833-227-3180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-03
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health