Provider Demographics
NPI:1679741227
Name:PREMIER INTEGRATED MEDICAL ASSOC. LTD
Entity Type:Organization
Organization Name:PREMIER INTEGRATED MEDICAL ASSOC. LTD
Other - Org Name:PRIMED PHYSICIANS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:COUCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-898-3600
Mailing Address - Street 1:500 LINCOLN PARK BLVD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-3492
Mailing Address - Country:US
Mailing Address - Phone:937-312-8155
Mailing Address - Fax:937-293-9231
Practice Address - Street 1:500 LINCOLN PARK BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-3492
Practice Address - Country:US
Practice Address - Phone:937-312-8155
Practice Address - Fax:937-293-9231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-18
Last Update Date:2008-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports MedicineGroup - Multi-Specialty