Premise 1 Medical Holding LLC

Primary specialty

Electrodiagnostic Medicine PhysicianTaxonomy code 204R00000X

Legal business name

PREMISE 1 MEDICAL HOLDING LLC

Practice address

3100 Monticello Ave
210
Dallas, TX 75205-3442

Phone

(214) 269-3875

Fax

(903) 328-6568

NPI assigned

May 4, 2016

Last updated

May 4, 2016By 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

Paul SC

Title

Manager

Phone

(214) 315-6432

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1462320000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1462320000000",
    "number": "1578919940",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4516 LOVERS LN",
            "address_2": "331",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752256925",
            "telephone_number": "214-269-3875",
            "fax_number": "903-328-6568"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3100 MONTICELLO AVE",
            "address_2": "210",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752053442",
            "telephone_number": "214-269-3875",
            "fax_number": "903-328-6568"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMISE 1 MEDICAL HOLDING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-04",
        "last_updated": "2016-05-04",
        "status": "A",
        "authorized_official_last_name": "SC",
        "authorized_official_first_name": "PAUL",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "214-315-6432"
    },
    "taxonomies": [
        {
            "code": "204R00000X",
            "taxonomy_group": "",
            "desc": "Electrodiagnostic Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2016; 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.