MEDICARE: PREMIER HEALTH SPECIALISTS 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	213E00000X	Podiatrist
2	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1356681993
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIER HEALTH SPECIALISTS INC

Provider Business Mailing Address
First Line	:	9000 N MAIN ST
Second Line	:	STE 201
City	:	DAYTON
State	:	OH
Zip	:	45415-1180
Country	:	US
Telephone Number	:	937-435-6585
Fax Number	:	937-435-6563

Provider Business Practice Location Address
First Line	:	136 S LUDLOW ST
Second Line	:	FIRST FLOOR
City	:	DAYTON
State	:	OH
Zip	:	45402-1813
Country	:	US
Telephone Number	:	937-499-8273
Fax Number	:	937-223-9811

Authorized Official
Title or Position	:	CEO/PRESIDENT
Name	:	JONATHAN M SCHWARTZ
Credential	:	MD MBA
Telephone Number	:	937-499-9015

Provider Enumeration Date	:	02/19/2013
Last Update Date	:	02/20/2013

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