MEDICARE: PREMIER PHYSICIANS CENTERS 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	207R00000X	Internal Medicine Physician

Other Identifiers

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

General Provider Information

NPI Number	:	1922301555
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIER PHYSICIANS CENTERS INC

Provider Business Mailing Address
First Line	:	20525 CENTER RIDGE RD STE 220
Second Line	:
City	:	ROCKY RIVER
State	:	OH
Zip	:	44116-3424
Country	:	US
Telephone Number	:	440-895-5056
Fax Number	:	440-333-2935

Provider Business Practice Location Address
First Line	:	2709 FRANKLIN BLVD #2E
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44113
Country	:	US
Telephone Number	:	216-363-2203
Fax Number	:	216-363-2058

Authorized Official
Title or Position	:	CREDENTIALING & COMPLIANCE SPEC.
Name	:	TIFFANY COOPER
Credential	:
Telephone Number	:	440-895-5056

Provider Enumeration Date	:	12/21/2010
Last Update Date	:	12/21/2010

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