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General NPI Number Information
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NPI Number | 1780634279
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Entity Type | Organization
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Legal Business Name | PREMIER PHYSICIANS CENTERS, INC.
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Dates
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Enumeration Date | 05/12/2006
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Last Update Date | 03/26/2021
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Provider Practice Location Address
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Address Line | 24500 CENTER RIDGE RD STE 375
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City | WESTLAKE
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State | OH
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Zip | 44145-5631
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Country | US
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Telephone | 440-895-5057
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Fax | 440-895-5050
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Provider Business Mailing Address
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Address Line | PO BOX 639004
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City | CINCINNATI
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State | OH
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Zip | 45263-0002
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Country | US
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Telephone | 440-895-5010
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Fax | 440-895-5050
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Authorized Official
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Title or Position | COO
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Name | CHARLES MICA
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Credential |
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Telephone | 440-895-5057
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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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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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