Healthcare Provider Details

I. General information

NPI: 1952853483
Provider Name (Legal Business Name): PREMIERHEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2016
Last Update Date: 11/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 SUGAR CAMP CIR SUITE 200
OAKWOOD OH
45409-1977
US

IV. Provider business mailing address

105 SUGAR CAMP CIR SUITE 200
OAKWOOD OH
45409-1977
US

V. Phone/Fax

Practice location:
  • Phone: 937-222-3937
  • Fax: 937-223-5254
Mailing address:
  • Phone: 937-222-3937
  • Fax: 939-223-5254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number21675
License Number StateOH

VIII. Authorized Official

Name: MRS. LISA HEROLD
Title or Position: OPHTHALMIC TECHNICIAN
Credential: C.O.T
Phone: 937-222-3937