Provider Demographics
NPI:1033503719
Name:PREMIER HEALTH SYSTEMS INC
Entity Type:Organization
Organization Name:PREMIER HEALTH SYSTEMS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MISS
Authorized Official - First Name:ETHEL
Authorized Official - Middle Name:EHRIANO
Authorized Official - Last Name:AGBARHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:774-633-4876
Mailing Address - Street 1:22 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01501-1625
Mailing Address - Country:US
Mailing Address - Phone:774-633-4876
Mailing Address - Fax:
Practice Address - Street 1:22 MAIN ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:MA
Practice Address - Zip Code:01501-1625
Practice Address - Country:US
Practice Address - Phone:774-633-4876
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-20
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA305S00000X305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110099034/AOtherMASS HEALTH