Provider Demographics
NPI:1215522727
Name:PREMIER 2020, LLC
Entity type:Organization
Organization Name:PREMIER 2020, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:ZIMM
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:814-453-4575
Mailing Address - Street 1:2350 VILLAGE COMMON DR
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16506-4970
Mailing Address - Country:US
Mailing Address - Phone:814-453-4575
Mailing Address - Fax:814-459-3885
Practice Address - Street 1:2350 VILLAGE COMMON DR
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16506-4970
Practice Address - Country:US
Practice Address - Phone:814-453-4575
Practice Address - Fax:814-459-3885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-05
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery