| Premier Medical Group, LLC | |
|
409 W 1st St Bloomington IN 47403-2403 | |
| (561) 556-3721 | |
| Not Available |
| Full Name | Premier Medical Group, LLC |
|---|---|
| Speciality | Clinic/center - Rehabilitation, Substance Use Disorder |
| Location | 409 W 1st St, Bloomington, Indiana |
| Authorized Official Name and Position | Kirill Vesselov (MANAGER) |
| Authorized Official Contact | 5615563721 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Premier Medical Group, LLC 2925 10th Ave N Palm Springs FL 33461-3000 | Premier Medical Group, LLC 409 W 1st St Bloomington IN 47403-2403 Ph: (561) 556-3721 |
| NPI Number | 1104649946 |
|---|---|
| Provider Enumeration Date | 10/31/2024 |
| Last Update Date | 12/06/2024 |
| Certification Date | 12/06/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104649946 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | () | Secondary |
| 261QR0405X | Clinic/center - Rehabilitation, Substance Use Disorder | () | Primary |
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