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General NPI Number Information
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NPI Number | 1467624403
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Entity Type | Organization
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Legal Business Name | PREMIER HEALTH CLINIC
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Dates
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Enumeration Date | 03/31/2008
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Last Update Date | 03/31/2008
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Provider Practice Location Address
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Address Line | 6900 GRANGER RD #203
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City | INDEPENDENCE
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State | OH
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Zip | 44131-1414
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Country | US
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Telephone | 216-520-1220
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Fax | 216-520-1222
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Provider Business Mailing Address
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Address Line | 6900 GRANGER RD #203
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City | INDEPENDENCE
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State | OH
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Zip | 44131-1414
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Country | US
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Telephone | 216-520-1220
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Fax | 216-520-1222
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | JOHN E KOCKA
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Credential |
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Telephone | 216-520-1220
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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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