Provider Demographics
NPI:1770022170
Name:PREMIER HEALTH SPECIALISTS INC
Entity Type:Organization
Organization Name:PREMIER HEALTH SPECIALISTS INC
Other - Org Name:ADVANCED ANKLE AND FOOT SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:GUERRANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-991-3188
Mailing Address - Street 1:1520 S MAIN ST STE 210
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45409-2643
Mailing Address - Country:US
Mailing Address - Phone:937-208-7250
Mailing Address - Fax:937-208-7245
Practice Address - Street 1:1520 S MAIN ST STE 210
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45409-2643
Practice Address - Country:US
Practice Address - Phone:937-208-7250
Practice Address - Fax:937-208-7245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-17
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies