Provider Demographics
NPI:1255716262
Name:PREMIER MEDICAL ASSOCIATES, PC
Entity type:Organization
Organization Name:PREMIER MEDICAL ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:DERUBEIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-457-0060
Mailing Address - Street 1:3824 NORTHERN PIKE
Mailing Address - Street 2:STE 700
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146-2141
Mailing Address - Country:US
Mailing Address - Phone:412-457-0060
Mailing Address - Fax:412-457-0067
Practice Address - Street 1:2140 ARDMORE BLVD
Practice Address - Street 2:STE 150
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15221-4860
Practice Address - Country:US
Practice Address - Phone:412-271-2400
Practice Address - Fax:412-271-0162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-21
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD039248E207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007504600079Medicaid
PA008511Medicare PIN
PA7417610001Medicare NSC