Provider Demographics
NPI:1194326629
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: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:440-467-1954
Mailing Address - Fax:
Practice Address - Street 1:18660 BAGLEY RD STE 101
Practice Address - Street 2:
Practice Address - City:MIDDLEBURG HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130-3483
Practice Address - Country:US
Practice Address - Phone:440-891-9395
Practice Address - Fax:440-891-1765
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PREMIER PHYSICIANS CENTERS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-11-02
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care