MEDICARE: PREMIER COMMUNITY HEALTH

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	261QX0100X	Occupational Medicine Clinic/Center

General Provider Information

NPI Number	:	1477070985
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIER COMMUNITY HEALTH

Provider Business Mailing Address
First Line	:	998 S DORSET RD STE 206
Second Line	:
City	:	TROY
State	:	OH
Zip	:	45373-4748
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	998 S DORSET RD STE 206
Second Line	:
City	:	TROY
State	:	OH
Zip	:	45373-4748
Country	:	US
Telephone Number	:	937-440-7766
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT & CEO
Name	:	PAULA THOMPSON
Credential	:
Telephone Number	:	937-208-6400

Provider Enumeration Date	:	08/25/2017
Last Update Date	:	08/25/2017

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