Provider Demographics
NPI:1982867396
Name:PREMIER MEDICAL & REHABILITATION CENTER, P.C.
Entity Type:Organization
Organization Name:PREMIER MEDICAL & REHABILITATION CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:SMARSH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:717-763-1222
Mailing Address - Street 1:99 NOVEMBER DR
Mailing Address - Street 2:SUITE 99
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011-5064
Mailing Address - Country:US
Mailing Address - Phone:717-763-1222
Mailing Address - Fax:717-763-2072
Practice Address - Street 1:99 NOVEMBER DR
Practice Address - Street 2:SUITE 99
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-5064
Practice Address - Country:US
Practice Address - Phone:717-763-1222
Practice Address - Fax:717-763-2072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-07
Last Update Date:2013-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC003170L111NR0400X
PATP006674B163WR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
No163WR0400XNursing Service ProvidersRegistered NurseRehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA6273630001Medicare NSC