MEDICARE: PREMIER PHYSICIANS CENTERS INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center
2	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1023693215
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIER PHYSICIANS CENTERS INC.

Provider Business Mailing Address
First Line	:	24500 CENTER RIDGE RD STE 375
Second Line	:
City	:	WESTLAKE
State	:	OH
Zip	:	44145-5631
Country	:	US
Telephone Number	:	440-467-1954
Fax Number	:

Provider Business Practice Location Address
First Line	:	2709 FRANKLIN BLVD FL 2E
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44113-2993
Country	:	US
Telephone Number	:	216-696-4140
Fax Number	:

Authorized Official
Title or Position	:	COO
Name	:	CHARLES MICA
Credential	:
Telephone Number	:	440-895-5057

Provider Enumeration Date	:	03/10/2021
Last Update Date	:	03/10/2021

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