Basic Information
| Provider Information | |||||||||
| NPI: | 1487320735 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PREMIER ASSOCIATES FOR THE HEALTHCARE OF WOMEN LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8645 N MILITARY TRL STE 508 | ||||||||
| Address2: | |||||||||
| City: | WEST PALM BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334106296 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5616308001 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1700 S 23RD ST | ||||||||
| Address2: | |||||||||
| City: | FORT PIERCE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 349504803 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7723354000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2021 | ||||||||
| LastUpdateDate: | 08/17/2021 | ||||||||
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| AuthorizedOfficialLastName: | STOESSEL | ||||||||
| AuthorizedOfficialFirstName: | RUEL | ||||||||
| AuthorizedOfficialMiddleName: | TYRONE | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5616308001 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | PREMIER ASSOCIATES FOR THE HEALTHCARE OF WOMEN LLC | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 08/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.