Provider Demographics
NPI:1104412477
Name:PREMIER PHYSICIANS CENTERS, INC.
Entity type:Organization
Organization Name:PREMIER PHYSICIANS CENTERS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:MICA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-895-5057
Mailing Address - Street 1:24500 CENTER RIDGE RD STE 375
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-5631
Mailing Address - Country:US
Mailing Address - Phone:440-895-5010
Mailing Address - Fax:440-895-5050
Practice Address - Street 1:18697 BAGLEY RD # A317
Practice Address - Street 2:
Practice Address - City:MIDDLEBURG HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130-3417
Practice Address - Country:US
Practice Address - Phone:440-816-6030
Practice Address - Fax:440-816-4268
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PREMIER PHYSICIANS CENTERS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-12-21
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic