Provider Demographics
NPI:1073552329
Name:PREMIER PHYSICIANS CENTERS, INC.
Entity Type:Organization
Organization Name:PREMIER PHYSICIANS CENTERS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:E
Authorized Official - Last Name:WIEDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-895-5021
Mailing Address - Street 1:20525 CENTER RIDGE RD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:ROCKY RIVER
Mailing Address - State:OH
Mailing Address - Zip Code:44116-3437
Mailing Address - Country:US
Mailing Address - Phone:440-895-5021
Mailing Address - Fax:440-895-5050
Practice Address - Street 1:14600 DETROIT AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107-4207
Practice Address - Country:US
Practice Address - Phone:216-227-0717
Practice Address - Fax:216-227-0827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-05
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty