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NPI Code Detail

MEDICARE: PREMIER PROFESSIOAL GROUP, LLC

MEDICARE: PREMIER PROFESSIOAL GROUP, LLC
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
11041S0200XSchool Social Worker

General Provider Information

NPI Number : 1841709458
Entity Type Code : Organization
Provider Name (Legal Business Name) : PREMIER PROFESSIOAL GROUP, LLC
Provider Business Mailing Address
First Line : 3806 DRIFTWOOD RD
Second Line :
City : TOLEDO
State : OH
Zip : 43614-3435
Country : US
Telephone Number : 419-509-6776
Fax Number :
Provider Business Practice Location Address
First Line : 5025 GLENDALE AVE
Second Line :
City : TOLEDO
State : OH
Zip : 43614-1855
Country : US
Telephone Number : 419-509-6776
Fax Number :
Authorized Official
Title or Position : FOUNDER/CEO
Name : MR. DAVID L BUSH
Credential :
Telephone Number : 419-509-6776
Provider Enumeration Date : 09/26/2017
Last Update Date : 09/26/2017

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Directions to “PREMIER PROFESSIOAL GROUP, LLC ” Practice Location

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