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General NPI Number Information
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NPI Number | 1629194147
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Entity Type | Organization
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Legal Business Name | PREMIER PEDIATRICS
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Dates
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Enumeration Date | 03/22/2007
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Last Update Date | 06/10/2011
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Provider Practice Location Address
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Address Line | 26040 DETROIT RD SUITE 7
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City | WESTLAKE
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State | OH
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Zip | 44145-2481
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Country | US
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Telephone | 440-871-1717
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Fax | 440-871-3098
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Provider Business Mailing Address
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Address Line | 26040 DETROIT RD SUITE 7
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City | WESTLAKE
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State | OH
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Zip | 44145-2481
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Country | US
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Telephone | 440-871-1717
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Fax | 440-871-3098
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOHN B BENNET
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Credential |
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Telephone | 440-871-1717
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 35-05-6333
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License Number State | OH
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