| Premiere Gi PLLC | |
|
11505 Palmbrush Trl Ste 200 Lakewood Ranch FL 34202-2904 | |
| (941) 334-9040 | |
| (941) 334-9030 |
| Full Name | Premiere Gi PLLC |
|---|---|
| Speciality | Internal Medicine |
| Location | 11505 Palmbrush Trl Ste 200, Lakewood Ranch, Florida |
| Authorized Official Name and Position | Arun Khazanchi (MEMBER OWNER) |
| Authorized Official Contact | 9413349040 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Premiere Gi PLLC 11505 Palmbrush Trl Ste 200 Lakewood Ranch FL 34202-2904 Ph: (941) 334-9040 | Premiere Gi PLLC 11505 Palmbrush Trl Ste 200 Lakewood Ranch FL 34202-2904 Ph: (941) 334-9040 |
| NPI Number | 1336829894 |
|---|---|
| Provider Enumeration Date | 07/20/2023 |
| Last Update Date | 07/20/2023 |
| Certification Date | 07/20/2023 |
| Medicare PECOS PAC ID | 4284098906 |
|---|---|
| Medicare Enrollment ID | O20230914000821 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336829894 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0100X | Internal Medicine - Gastroenterology | () | Primary |
| Provider Name | Arun P Khazanchi |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1003961236 PECOS PAC ID: 8022104751 Enrollment ID: I20071011000114 |
| Provider Name | Amanda B Lee |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376864264 PECOS PAC ID: 2365576113 Enrollment ID: I20100816000217 |
| Provider Name | Mark Kocab |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1942271606 PECOS PAC ID: 4587716873 Enrollment ID: I20100826000344 |
| Provider Name | Tracy Renee' Osborne |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1902268998 PECOS PAC ID: 5395022446 Enrollment ID: I20170427002217 |
| Provider Name | Joshua B Tennenbaum |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1356543441 PECOS PAC ID: 8921294943 Enrollment ID: I20250117000875 |
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