Provider Demographics
NPI:1902177017
Name:PREMIERE CONCEPTS
Entity Type:Organization
Organization Name:PREMIERE CONCEPTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:LANKENAU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-462-1285
Mailing Address - Street 1:5460 WARD RD.
Mailing Address - Street 2:#300
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80002
Mailing Address - Country:US
Mailing Address - Phone:303-351-7060
Mailing Address - Fax:303-395-0826
Practice Address - Street 1:4080 YOUNGFIELD ST
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-3862
Practice Address - Country:US
Practice Address - Phone:281-462-1285
Practice Address - Fax:281-462-1554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-20
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty