Healthcare Provider Details

I. General information

NPI: 1710223763
Provider Name (Legal Business Name): PREMIER HEALTH SPECIALISTS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2012
Last Update Date: 05/01/2013
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

Practice location:
  • Phone: 937-222-3937
  • Fax: 937-496-3595
Mailing address:
  • Phone: 937-222-3937
  • Fax: 937-496-3595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: JONATHAN M SCHWARTZ
Title or Position: CEO/PRESIDENT
Credential: MD MBA
Phone: 937-499-9015