Provider Demographics
NPI:1851755052
Name:PREMIER INJURY MEDICINE, LLC
Entity Type:Organization
Organization Name:PREMIER INJURY MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTIAGO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:614-570-9659
Mailing Address - Street 1:247 GLEN VILLAGE CT
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43065-9677
Mailing Address - Country:US
Mailing Address - Phone:614-431-8869
Mailing Address - Fax:614-431-9910
Practice Address - Street 1:1430 S HIGH ST
Practice Address - Street 2:SUITE C
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43207-1045
Practice Address - Country:US
Practice Address - Phone:614-444-5340
Practice Address - Fax:614-444-5342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35057517261QX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH581025142-00OtherWORKERS' COMPENSATION
OH35057517OtherSTATE MEDICLA LICENSE
OH0759362Medicaid
OH0759362Medicaid
OH35057517OtherSTATE MEDICLA LICENSE
OHE76643Medicare UPIN