Healthcare Provider Details

I. General information

NPI: 1568702777
Provider Name (Legal Business Name): PREMIERT ENTERPRISE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2013
Last Update Date: 02/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91 W GLENWOOD AVE
AKRON OH
44304-1019
US

IV. Provider business mailing address

91 W GLENWOOD AVE
AKRON OH
44304-1019
US

V. Phone/Fax

Practice location:
  • Phone: 330-535-7433
  • Fax: 330-535-7346
Mailing address:
  • Phone: 330-535-7433
  • Fax: 330-535-7346

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License NumberRN515829
License Number StateOH

VIII. Authorized Official

Name: MR. BERT MCELRATH
Title or Position: OPER. MGR.
Credential:
Phone: 330-535-7433