Provider Demographics
NPI:1720319353
Name:PREMIER EMG LLC
Entity Type:Organization
Organization Name:PREMIER EMG LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLIENT SERVICES MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-965-8041
Mailing Address - Street 1:PO BOX 42878
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-0878
Mailing Address - Country:US
Mailing Address - Phone:513-965-8041
Mailing Address - Fax:513-965-8093
Practice Address - Street 1:8271 CORNELL RD
Practice Address - Street 2:SUITE 730
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45249-2290
Practice Address - Country:US
Practice Address - Phone:513-317-3734
Practice Address - Fax:513-965-8093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-21
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9386931Medicare PIN