Healthcare Provider Details

I. General information

NPI: 1235906405
Provider Name (Legal Business Name): PREMIER PAIN TREATMENT INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2023
Last Update Date: 07/19/2024
Certification Date: 07/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4701 CENTRAL AVE
MIDDLETOWN OH
45044-5353
US

IV. Provider business mailing address

PO BOX 330
LOVELAND OH
45140-0330
US

V. Phone/Fax

Practice location:
  • Phone: 513-454-7246
  • Fax:
Mailing address:
  • Phone: 513-454-7146
  • Fax:

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 Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: MICHAEL DONALD DANKO
Title or Position: OWNER
Credential: MD
Phone: 513-454-7246