Provider Demographics
NPI:1114213055
Name:PREMIER HEALTH SPECIALISTS INC
Entity Type:Organization
Organization Name:PREMIER HEALTH SPECIALISTS INC
Other - Org Name:COMPREHENSIVE BURN AND WOUND SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:DANIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-435-4263
Mailing Address - Street 1:1 WYOMING ST
Mailing Address - Street 2:SUITE 3272
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45409-2722
Mailing Address - Country:US
Mailing Address - Phone:937-208-6790
Mailing Address - Fax:937-208-6797
Practice Address - Street 1:1 WYOMING ST
Practice Address - Street 2:SUITE 3272
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45409-2722
Practice Address - Country:US
Practice Address - Phone:937-208-6790
Practice Address - Fax:937-208-6797
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PREMIER HEALTH SPECIALISTS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-06-20
Last Update Date:2013-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0052094Medicaid
OH9353865Medicare PIN