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	:	1902676737
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIER COMMUNITY HEALTH

Provider Business Mailing Address
First Line	:	PO BOX 933338
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44193-0037
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	35 OVERBROOK DR
Second Line	:
City	:	MONROE
State	:	OH
Zip	:	45050-1199
Country	:	US
Telephone Number	:	513-402-6350
Fax Number	:

Authorized Official
Title or Position	:	SENIOR DIRECTOR OPERATIONS
Name	:	SANDRA HAIG
Credential	:
Telephone Number	:	937-208-6495

Provider Enumeration Date	:	01/03/2024
Last Update Date	:	01/03/2024

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