Provider Demographics
NPI:1942006853
Name:PREMIER PEDIATRICS, LLC
Entity type:Organization
Organization Name:PREMIER PEDIATRICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAHAB
Authorized Official - Middle Name:
Authorized Official - Last Name:EUNUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-509-5082
Mailing Address - Street 1:7960 SW 60TH AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34476-6409
Mailing Address - Country:US
Mailing Address - Phone:352-671-6741
Mailing Address - Fax:352-671-6742
Practice Address - Street 1:2040 NE 95TH ST
Practice Address - Street 2:
Practice Address - City:ANTHONY
Practice Address - State:FL
Practice Address - Zip Code:32617-3628
Practice Address - Country:US
Practice Address - Phone:352-509-5082
Practice Address - Fax:352-509-5083
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PREMIER PEDIATRICS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-02-21
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty