Provider Demographics
NPI:1467624403
Name:PREMIER HEALTH CLINIC
Entity Type:Organization
Organization Name:PREMIER HEALTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:E
Authorized Official - Last Name:KOCKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-520-1220
Mailing Address - Street 1:6900 GRANGER RD
Mailing Address - Street 2:#203
Mailing Address - City:INDEPENDENCE
Mailing Address - State:OH
Mailing Address - Zip Code:44131-1414
Mailing Address - Country:US
Mailing Address - Phone:216-520-1220
Mailing Address - Fax:216-520-1222
Practice Address - Street 1:6900 GRANGER RD
Practice Address - Street 2:#203
Practice Address - City:INDEPENDENCE
Practice Address - State:OH
Practice Address - Zip Code:44131-1414
Practice Address - Country:US
Practice Address - Phone:216-520-1220
Practice Address - Fax:216-520-1222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-31
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty