Provider Demographics
NPI:1790069698
Name:PREMIER INTERNAL MEDICINE LLC
Entity Type:Organization
Organization Name:PREMIER INTERNAL MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER/DIRECTOR RCM
Authorized Official - Prefix:
Authorized Official - First Name:SRINIVAS ANAND RAO
Authorized Official - Middle Name:
Authorized Official - Last Name:PONNERI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-373-4202
Mailing Address - Street 1:6275 E BROAD ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-1504
Mailing Address - Country:US
Mailing Address - Phone:614-861-0967
Mailing Address - Fax:614-861-0930
Practice Address - Street 1:6275 E BROAD ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-1504
Practice Address - Country:US
Practice Address - Phone:614-824-3394
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-11
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty