Healthcare Provider Details

I. General information

NPI: 1154472934
Provider Name (Legal Business Name): PREMIER HEALTH SPECIALISTS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 11/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 S DIXIE DR SUITE 40
VANDALIA OH
45377-2657
US

IV. Provider business mailing address

900 S DIXIE DR SUITE 40
VANDALIA OH
45377-2657
US

V. Phone/Fax

Practice location:
  • Phone: 937-890-6644
  • Fax: 937-890-1726
Mailing address:
  • Phone: 937-890-6644
  • Fax: 937-890-1726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER DANIS
Title or Position: PRESIDENT/CEO
Credential:
Phone: 937-499-9015