Provider Demographics
NPI:1083987002
Name:PREMIER URGENT CARE OF EASTGATE
Entity type:Organization
Organization Name:PREMIER URGENT CARE OF EASTGATE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:MACHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:GIORDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-723-2111
Mailing Address - Street 1:4530 EASTGATE BLVD
Mailing Address - Street 2:STE B-616
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45245-1266
Mailing Address - Country:US
Mailing Address - Phone:513-752-1999
Mailing Address - Fax:513-752-0914
Practice Address - Street 1:4530 EASTGATE BLVD
Practice Address - Street 2:STE B-616
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45245-1266
Practice Address - Country:US
Practice Address - Phone:513-752-1999
Practice Address - Fax:513-752-0914
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PREMIER HEALTH CARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-02-22
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care