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NPI Code Detail

MEDICARE: PREMIER INTEGRATED MEDICAL ASSOC LTD

MEDICARE: PREMIER INTEGRATED MEDICAL ASSOC LTD
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
1208000000XPediatrics Physician
2207Q00000XFamily Medicine Physician

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1CA2478OTHERMEDICARE RR GROUP NUMBER

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1811953052
Entity Type Code : Organization
Provider Name (Legal Business Name) : PREMIER INTEGRATED MEDICAL ASSOC LTD
Provider Business Mailing Address
First Line : 25 MERCHANT ST
Second Line : STE 220 - ATTN CREDENTIALING
City : CINCINNATI
State : OH
Zip : 45246-3740
Country : US
Telephone Number : 513-533-1199
Fax Number : 513-645-9827
Provider Business Practice Location Address
First Line : 1152 W 3RD ST
Second Line :
City : DAYTON
State : OH
Zip : 45402-6812
Country : US
Telephone Number : 937-268-3483
Fax Number : 937-268-1884
Authorized Official
Title or Position : PRESIDENT
Name : DR. MARK A COUCH
Credential : MD
Telephone Number : 937-898-3600
Provider Enumeration Date : 04/25/2006
Last Update Date : 07/15/2019

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Directions to “PREMIER INTEGRATED MEDICAL ASSOC LTD ” Practice Location

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