Provider Demographics
NPI:1912345901
Name:PREMIER PLASTIC SURGERY AND DERMATOLOGY ASSOCIATES, LTD
Entity type:Organization
Organization Name:PREMIER PLASTIC SURGERY AND DERMATOLOGY ASSOCIATES, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:A
Authorized Official - Last Name:REEDER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:937-438-5333
Mailing Address - Street 1:6728 LOOP RD
Mailing Address - Street 2:BLDG. 5, SUITE 301
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45459-2196
Mailing Address - Country:US
Mailing Address - Phone:937-438-5333
Mailing Address - Fax:937-438-0160
Practice Address - Street 1:6728 LOOP RD
Practice Address - Street 2:BLDG. 5, SUITE 301
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459-2196
Practice Address - Country:US
Practice Address - Phone:937-438-5333
Practice Address - Fax:937-438-0160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-12
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363LF0000X
OH34005419208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0847132Medicaid
OH0847132Medicaid