Healthcare Provider Details

I. General information

NPI: 1336836311
Provider Name (Legal Business Name): PREMIER COMMUNITY HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2023
Last Update Date: 04/20/2023
Certification Date: 04/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2655 W NATIONAL RD
SPRINGFIELD OH
45504-3617
US

IV. Provider business mailing address

PO BOX 933338
CLEVELAND OH
44193-0037
US

V. Phone/Fax

Practice location:
  • Phone: 937-525-5578
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
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: DIRECTOR, IT & REVENUE CYCLE
Credential:
Phone: 937-208-6495