MEDICARE: PREMIER PHYSICIANS CENTERS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194224170
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIER PHYSICIANS CENTERS INC

Provider Business Mailing Address
First Line	:	24651 CENTER RIDGE RD STE 350
Second Line	:
City	:	WESTLAKE
State	:	OH
Zip	:	44145-5627
Country	:	US
Telephone Number	:	440-895-5056
Fax Number	:	440-895-5050

Provider Business Practice Location Address
First Line	:	25761 LORAIN RD FL 2
Second Line	:
City	:	NORTH OLMSTED
State	:	OH
Zip	:	44070-3368
Country	:	US
Telephone Number	:	440-734-4900
Fax Number	:	440-734-4902

Authorized Official
Title or Position	:	CFO
Name	:	JEFF DYBIEC
Credential	:
Telephone Number	:	440-895-5036

Provider Enumeration Date	:	02/06/2018
Last Update Date	:	06/16/2018

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