Healthcare Provider Details
I. General information
NPI: 1033455373
Provider Name (Legal Business Name): PREMIER HEALTH SPECIALISTS INC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 12/13/2012
Last Update Date: 11/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
105 SUGAR CAMP CIR STE 200
DAYTON OH
45409-1962
US
IV. Provider business mailing address
105 SUGAR CAMP CIR STE 200
DAYTON OH
45409-1962
US
V. Phone/Fax
- Phone: 937-222-3937
- Fax: 937-223-5416
- Phone: 937-222-3937
- Fax: 937-223-5416
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 207W00000X |
| Taxonomy | Ophthalmology Physician |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name:
CHRISTOPHER
J
DANIS
Title or Position: CEO/PRESIDENT
Credential: MD
Phone: 937-499-9015