Healthcare Provider Details

I. General information

NPI: 1912345901
Provider Name (Legal Business Name): PREMIER PLASTIC SURGERY AND DERMATOLOGY ASSOCIATES, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2013
Last Update Date: 06/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6728 LOOP RD BLDG. 5, SUITE 301
CENTERVILLE OH
45459-2196
US

IV. Provider business mailing address

6728 LOOP RD BLDG. 5, SUITE 301
CENTERVILLE OH
45459-2196
US

V. Phone/Fax

Practice location:
  • Phone: 937-438-5333
  • Fax: 937-438-0160
Mailing address:
  • Phone: 937-438-5333
  • Fax: 937-438-0160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number34005419
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. CHRISTOPHER A REEDER
Title or Position: OWNER/PHYSICIAN
Credential: D.O.
Phone: 937-438-5333