Provider Demographics
NPI:1629212279
Name:PREMIER HEALTH SPECIALISTS INC
Entity Type:Organization
Organization Name:PREMIER HEALTH SPECIALISTS INC
Other - Org Name:ADVANCED CARDIOVASCULAR INSTITUTE
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:
Authorized Official - Phone:937-499-8866
Mailing Address - Street 1:200 MEDICAL CENTER DR
Mailing Address - Street 2:STE 290A
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45005-2595
Mailing Address - Country:US
Mailing Address - Phone:513-425-7135
Mailing Address - Fax:513-420-4662
Practice Address - Street 1:200 MEDICAL CENTER DR
Practice Address - Street 2:STE 290A
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45005-2595
Practice Address - Country:US
Practice Address - Phone:513-425-7135
Practice Address - Fax:513-420-4662
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PREMIER HEALTH SPECIALISTS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-04-27
Last Update Date:2014-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0064005Medicaid
OH9353865Medicare PIN