Healthcare Provider Details

I. General information

NPI: 1982867396
Provider Name (Legal Business Name): PREMIER MEDICAL & REHABILITATION CENTER, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2008
Last Update Date: 10/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 NOVEMBER DR SUITE 99
CAMP HILL PA
17011-5064
US

IV. Provider business mailing address

99 NOVEMBER DR SUITE 99
CAMP HILL PA
17011-5064
US

V. Phone/Fax

Practice location:
  • Phone: 717-763-1222
  • Fax: 717-763-2072
Mailing address:
  • Phone: 717-763-1222
  • Fax: 717-763-2072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WR0400X
TaxonomyRehabilitation Registered Nurse
License NumberTP006674B
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberDC003170L
License Number StatePA

VIII. Authorized Official

Name: THOMAS J SMARSH
Title or Position: PRESIDENT
Credential: D.C
Phone: 717-763-1222