Healthcare Provider Details

I. General information

NPI: 1902211287
Provider Name (Legal Business Name): PREMIER HEALTH SPECIALISTS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2014
Last Update Date: 06/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WYOMING ST STE 3115
DAYTON OH
45409-2722
US

IV. Provider business mailing address

1 WYOMING ST STE 3115
DAYTON OH
45409-2722
US

V. Phone/Fax

Practice location:
  • Phone: 937-208-6745
  • Fax: 937-208-6746
Mailing address:
  • Phone: 937-208-6745
  • Fax: 937-208-6746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: KENNETH PRUNIER
Title or Position: CEO/PRESIDENT
Credential:
Phone: 937-499-8205