Provider Demographics
NPI:1194224170
Name:PREMIER PHYSICIANS CENTERS INC
Entity type:Organization
Organization Name:PREMIER PHYSICIANS CENTERS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:DYBIEC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-895-5036
Mailing Address - Street 1:24651 CENTER RIDGE RD STE 350
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-5627
Mailing Address - Country:US
Mailing Address - Phone:440-895-5056
Mailing Address - Fax:440-895-5050
Practice Address - Street 1:25761 LORAIN RD FL 2
Practice Address - Street 2:
Practice Address - City:NORTH OLMSTED
Practice Address - State:OH
Practice Address - Zip Code:44070-3368
Practice Address - Country:US
Practice Address - Phone:440-734-4900
Practice Address - Fax:440-734-4902
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PREMIER PHYSICIANS CENTERS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-02-06
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0119204Medicaid