Provider Demographics
NPI:1942483433
Name:PREMIER PHYSICIANS CENTERS, INC
Entity type:Organization
Organization Name:PREMIER PHYSICIANS CENTERS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERIUM CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DICK
Authorized Official - Middle Name:
Authorized Official - Last Name:FINTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-895-5056
Mailing Address - Street 1:24500 CENTER RIDGE RD STE 375
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-5631
Mailing Address - Country:US
Mailing Address - Phone:440-895-5056
Mailing Address - Fax:440-333-2935
Practice Address - Street 1:25200 CENTER RIDGE RD
Practice Address - Street 2:SUITE 3100
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-4141
Practice Address - Country:US
Practice Address - Phone:440-331-4559
Practice Address - Fax:440-333-2935
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PREMIER PHYSICIANS CENTERS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-07
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0791AS261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2040482Medicaid
490003414OtherRAILROAD MEDICARE GROUP #
1942483433OtherASC NPI GROUP #
D368301OtherGROUP IND DIAGNOSTICS LAB
4511OtherGROUP RR MEDICARE
3610861OtherASC GROUP MEDICARE #
D368301OtherGROUP IND DIAGNOSTICS LAB
1942483433OtherASC NPI GROUP #