Healthcare Provider Details

I. General information

NPI: 1306652300
Provider Name (Legal Business Name): PREMIER COMMUNITY HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2024
Last Update Date: 12/05/2024
Certification Date: 12/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1629 S MAIN ST
SPRINGBORO OH
45066-2504
US

IV. Provider business mailing address

PO BOX 933338
CLEVELAND OH
44193-0037
US

V. Phone/Fax

Practice location:
  • Phone: 937-208-6400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SANDRA HAIG
Title or Position: SENIOR DIRECTOR OPERATIONS
Credential:
Phone: 937-208-6495