Provider Demographics
NPI:1508942400
Name:PREMIER CARE PEDIATRICS, INC.
Entity Type:Organization
Organization Name:PREMIER CARE PEDIATRICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:SANSOTERRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-841-5500
Mailing Address - Street 1:2642 ELM RD.
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44410
Mailing Address - Country:US
Mailing Address - Phone:330-841-5500
Mailing Address - Fax:330-841-5510
Practice Address - Street 1:2642 ELM RD.
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:OH
Practice Address - Zip Code:44410
Practice Address - Country:US
Practice Address - Phone:330-841-5500
Practice Address - Fax:330-841-5510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty