Provider Demographics
NPI:1770142960
Name:PREMEIR PHYSICIANS MEDICAL GROUP
Entity type:Organization
Organization Name:PREMEIR PHYSICIANS MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:BABBO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-856-2928
Mailing Address - Street 1:8323 E MARKET ST
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44484-2342
Mailing Address - Country:US
Mailing Address - Phone:330-856-2928
Mailing Address - Fax:330-609-5553
Practice Address - Street 1:8323 E MARKET ST
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484-2342
Practice Address - Country:US
Practice Address - Phone:330-856-2928
Practice Address - Fax:330-609-5553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-11
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty