Healthcare Provider Details

I. General information

NPI: 1538398078
Provider Name (Legal Business Name): PREMIER HEALTH SPECIALISTS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2009
Last Update Date: 09/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 N MAIN ST STE 227
DAYTON OH
45415-1180
US

IV. Provider business mailing address

9000 N MAIN ST STE 227
DAYTON OH
45415-1180
US

V. Phone/Fax

Practice location:
  • Phone: 937-832-4773
  • Fax: 937-832-2986
Mailing address:
  • Phone: 937-832-4773
  • Fax: 937-832-2986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER DANIS
Title or Position: PRESIDENT/CEO
Credential:
Phone: 937-435-4263