Provider Demographics
NPI:1396166302
Name:PREMIER MENTAL HEALTH CARE,PC
Entity type:Organization
Organization Name:PREMIER MENTAL HEALTH CARE,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BENYAM
Authorized Official - Middle Name:G
Authorized Official - Last Name:TEGENE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:717-695-7825
Mailing Address - Street 1:3461 MARKET ST
Mailing Address - Street 2:SUITE # 102
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011-4412
Mailing Address - Country:US
Mailing Address - Phone:717-695-7825
Mailing Address - Fax:717-695-7843
Practice Address - Street 1:3461 MARKET ST
Practice Address - Street 2:SUITE # 102
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-4412
Practice Address - Country:US
Practice Address - Phone:717-695-7825
Practice Address - Fax:717-695-7843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-17
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4190762084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA063261LRRMedicare PIN