Premium Medical Associates Healthcare LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

PREMIUM MEDICAL ASSOCIATES HEALTHCARE LLC

Practice address

600 W College Ave
Tallahassee, FL 32306

Phone

(407) 498-6934

Fax

(407) 386-7878

NPI assigned

Jun 10, 2021

Last updated

Jun 10, 2021By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Lyne Pierre

Title

Business Partner

Phone

(407) 860-1511

Specialties & licenses 2

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1623283200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1623283200000",
    "number": "1306413927",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4651 BABCOCK ST NE STE 18",
            "city": "PALM BAY",
            "state": "FL",
            "postal_code": "329052808",
            "telephone_number": "407-498-6934",
            "fax_number": "407-386-7878"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 W COLLEGE AVE",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "32306",
            "telephone_number": "407-498-6934",
            "fax_number": "407-386-7878"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIUM MEDICAL ASSOCIATES HEALTHCARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-10",
        "last_updated": "2021-06-10",
        "certification_date": "2021-05-25",
        "status": "A",
        "authorized_official_last_name": "PIERRE",
        "authorized_official_first_name": "LYNE",
        "authorized_official_title_or_position": "BUSINESS PARTNER",
        "authorized_official_telephone_number": "407-860-1511"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Premium Medical Associates Healthcare LLC
• Presbyterian Retirement Communities, Inc. (Westminster Oaks)
• Shaneka Dionne President, LCSW
• Patsy Dianne Presley, MSW, LCSW
• Prestige Care Florida LLC

• Clinic/Center in Tallahassee, FL
• Providers in Tallahassee, FL by specialty
• Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.