Healthcare Provider Details

I. General information

NPI: 1356681993
Provider Name (Legal Business Name): PREMIER HEALTH SPECIALISTS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2013
Last Update Date: 02/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 S LUDLOW ST FIRST FLOOR
DAYTON OH
45402-1813
US

IV. Provider business mailing address

9000 N MAIN ST STE 201
DAYTON OH
45415-1180
US

V. Phone/Fax

Practice location:
  • Phone: 937-499-8273
  • Fax: 937-223-9811
Mailing address:
  • Phone: 937-435-6585
  • Fax: 937-435-6563

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number StateNULL

VIII. Authorized Official

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