Provider Demographics
NPI:1356308662
Name:PREMIER INTEGRATED MEDICAL ASSOC
Entity Type:Organization
Organization Name:PREMIER INTEGRATED MEDICAL ASSOC
Other - Org Name:PRIMED PHYSICAINS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JANETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:FROEHLICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-426-0106
Mailing Address - Street 1:25 MERCHANT ST
Mailing Address - Street 2:STE 220 - ATTN CREDENTIALING
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45246-3740
Mailing Address - Country:US
Mailing Address - Phone:513-533-1199
Mailing Address - Fax:513-645-9827
Practice Address - Street 1:8501 OLD TROY PIKE STE 120
Practice Address - Street 2:
Practice Address - City:HUBER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:45424-1061
Practice Address - Country:US
Practice Address - Phone:937-237-4945
Practice Address - Fax:937-237-4925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-28
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2098199Medicaid
OH2098199Medicaid
OH2098199Medicaid