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General NPI Number Information
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NPI Number | 1457317679
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Entity Type | Organization
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Legal Business Name | PREMIER INTEGRATED MEDICAL ASSOCIATES, LTD
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Dates
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Enumeration Date | 04/25/2006
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Last Update Date | 07/15/2019
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Provider Practice Location Address
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Address Line | 1 E NATIONAL RD
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City | VANDALIA
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State | OH
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Zip | 45377-2116
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Country | US
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Telephone | 937-898-3600
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Fax | 937-898-2731
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Provider Business Mailing Address
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Address Line | 25 MERCHANT ST STE 220 - ATTN CREDENTIALING
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City | CINCINNATI
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State | OH
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Zip | 45246-3740
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Country | US
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Telephone | 513-533-1199
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Fax | 513-645-9827
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARK A COUCH
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Credential | MD
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Telephone | 937-898-3600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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