Healthcare Provider Details

I. General information

NPI: 1013339324
Provider Name (Legal Business Name): PREMIER INDEPENDENT QUALITY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2014
Last Update Date: 01/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 SOUTH BROADWAY STREET
DAYTON OH
45402
US

IV. Provider business mailing address

111 SOUTH BROADWAY STREET
DAYTON OH
45402
US

V. Phone/Fax

Practice location:
  • Phone: 937-528-1027
  • Fax:
Mailing address:
  • Phone: 937-528-1027
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number52793274
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License NumberRU426244
License Number StateOH

VIII. Authorized Official

Name: MRS. TAMARA EVANS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 937-528-1027