Healthcare Provider Details

I. General information

NPI: 1083079941
Provider Name (Legal Business Name): PREMIER PAIN TREATMENT INSTITUTE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2015
Last Update Date: 01/24/2024
Certification Date: 01/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 MATTEC DR
LOVELAND OH
45140-7300
US

IV. Provider business mailing address

PO BOX 35914
BELFAST ME
04915-1201
US

V. Phone/Fax

Practice location:
  • Phone: 513-454-7246
  • Fax:
Mailing address:
  • Phone: 888-488-8289
  • Fax: 502-919-9780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL DONALD DANKO
Title or Position: OWNER
Credential: M.D.
Phone: 502-777-5607