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NPI Code Detail

MEDICARE: PREMIER INTEGRATED MEDICAL ASSOCIATES, LTD

MEDICARE: PREMIER INTEGRATED MEDICAL ASSOCIATES, LTD
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
1291U00000XClinical Medical Laboratory

Other Identifiers

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

General Provider Information

NPI Number : 1710944053
Entity Type Code : Organization
Provider Name (Legal Business Name) : PREMIER INTEGRATED MEDICAL ASSOCIATES, LTD
Provider Business Mailing Address
First Line : 25 MERCHANT ST STE 220
Second Line :
City : CINCINNATI
State : OH
Zip : 45246-3740
Country : US
Telephone Number : 513-533-1199
Fax Number : 513-645-9827
Provider Business Practice Location Address
First Line : 948 PATTERSON RD
Second Line :
City : DAYTON
State : OH
Zip : 45419-4336
Country : US
Telephone Number : 937-298-7434
Fax Number : 937-299-8252
Authorized Official
Title or Position : PRESIDENT
Name : MARK COUCH
Credential : M.D.
Telephone Number : 937-898-3600
Provider Enumeration Date : 04/28/2006
Last Update Date : 04/24/2020

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