Provider Demographics
NPI:1619209475
Name:PREMIER HEALTH CARE LLC
Entity Type:Organization
Organization Name:PREMIER HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SON
Authorized Official - Middle Name:M
Authorized Official - Last Name:BACH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-366-1082
Mailing Address - Street 1:P.O. BOX 644671
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:OH
Mailing Address - Zip Code:15264-4671
Mailing Address - Country:US
Mailing Address - Phone:937-366-1082
Mailing Address - Fax:
Practice Address - Street 1:2845 PROGRESS WAY
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:OH
Practice Address - Zip Code:45177
Practice Address - Country:US
Practice Address - Phone:937-366-1082
Practice Address - Fax:937-366-1083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-04
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-088053261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3027763Medicaid
OH9387561Medicare UPIN