Provider Demographics
NPI:1205546967
Name:PREMIER WOUND SOLUTIONS LLC
Entity type:Organization
Organization Name:PREMIER WOUND SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-626-1212
Mailing Address - Street 1:3440 N 16TH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-7125
Mailing Address - Country:US
Mailing Address - Phone:602-441-2802
Mailing Address - Fax:
Practice Address - Street 1:3440 N 16TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-7125
Practice Address - Country:US
Practice Address - Phone:602-441-2808
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PREMIER LAB SOLUTIONS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-12-02
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty