Provider Demographics
NPI:1811039928
Name:PREMIER PHYSICAL ELECTRODIAGNOSTIC MEDICINE,LLC
Entity Type:Organization
Organization Name:PREMIER PHYSICAL ELECTRODIAGNOSTIC MEDICINE,LLC
Other - Org Name:PPEM
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:A
Authorized Official - Last Name:WHEELING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:814-459-0202
Mailing Address - Street 1:PO BOX 377
Mailing Address - Street 2:
Mailing Address - City:MC KEAN
Mailing Address - State:PA
Mailing Address - Zip Code:16426-0377
Mailing Address - Country:US
Mailing Address - Phone:814-459-0202
Mailing Address - Fax:814-459-0208
Practice Address - Street 1:333 STATE ST
Practice Address - Street 2:SUITE 104
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16507-1450
Practice Address - Country:US
Practice Address - Phone:814-459-0202
Practice Address - Fax:814-459-0208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA098557Medicare ID - Type Unspecified