Healthcare Provider Details

I. General information

NPI: 1699307462
Provider Name (Legal Business Name): PREMIER RHEUMATOLOGY GROUP AND INFUSION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2020
Last Update Date: 09/12/2025
Certification Date: 09/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18660 BAGLEY RD STE 102B
CLEVELAND OH
44130-3483
US

IV. Provider business mailing address

18660 BAGLEY RD STE 102B
CLEVELAND OH
44130-3483
US

V. Phone/Fax

Practice location:
  • Phone: 440-891-2413
  • Fax:
Mailing address:
  • Phone:
  • Fax: 440-673-1926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: CHERISH HOPE COGAR
Title or Position: AO
Credential: CMA
Phone: 216-466-7955