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General NPI Number Information
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NPI Number | 1013339324
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Entity Type | Organization
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Legal Business Name | PREMIER INDEPENDENT QUALITY SERVICES
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Dates
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Enumeration Date | 01/07/2014
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Last Update Date | 01/07/2014
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Provider Practice Location Address
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Address Line | 111 SOUTH BROADWAY STREET
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City | DAYTON
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State | OH
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Zip | 45402
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Country | US
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Telephone | 937-528-1027
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Fax |
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Provider Business Mailing Address
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Address Line | 111 SOUTH BROADWAY STREET
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City | DAYTON
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State | OH
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Zip | 45402
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Country | US
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Telephone | 937-528-1027
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. TAMARA EVANS
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Credential |
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Telephone | 937-528-1027
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number | RU426244
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 52793274
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License Number State | OH
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