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NPI Code Detail

MEDICARE: PREMIER PHYSICIANS CENTERS, INC.

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
1207Q00000XFamily Medicine Physician
2207RC0000XCardiovascular Disease Physician
3207R00000XInternal Medicine Physician

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2CA4511OTHERRR MEDICARE GROUP

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 : 1780634279
Entity Type Code : Organization
Provider Name (Legal Business Name) : PREMIER PHYSICIANS CENTERS, INC.
Provider Business Mailing Address
First Line : PO BOX 639004
Second Line :
City : CINCINNATI
State : OH
Zip : 45263-0002
Country : US
Telephone Number : 440-895-5010
Fax Number : 440-895-5050
Provider Business Practice Location Address
First Line : 24500 CENTER RIDGE RD STE 375
Second Line :
City : WESTLAKE
State : OH
Zip : 44145-5631
Country : US
Telephone Number : 440-895-5057
Fax Number : 440-895-5050
Authorized Official
Title or Position : COO
Name : CHARLES MICA
Credential :
Telephone Number : 440-895-5057
Provider Enumeration Date : 05/12/2006
Last Update Date : 03/26/2021

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