Healthcare Provider Details

I. General information

NPI: 1922301555
Provider Name (Legal Business Name): PREMIER PHYSICIANS CENTERS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2010
Last Update Date: 12/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2709 FRANKLIN BLVD #2E
CLEVELAND OH
44113
US

IV. Provider business mailing address

20525 CENTER RIDGE RD STE 220
ROCKY RIVER OH
44116-3424
US

V. Phone/Fax

Practice location:
  • Phone: 216-363-2203
  • Fax: 216-363-2058
Mailing address:
  • Phone: 440-895-5056
  • Fax: 440-333-2935

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: TIFFANY COOPER
Title or Position: CREDENTIALING & COMPLIANCE SPEC.
Credential:
Phone: 440-895-5056