1184804403 NPI number — PREMIER PAIN PHYSICIANS, LLC

Table of content: (NPI 1184804403)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184804403 NPI number — PREMIER PAIN PHYSICIANS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PREMIER PAIN PHYSICIANS, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184804403
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/14/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3131 S DIXIE DR STE 421
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MORAINE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45439-2223
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-297-6074
Provider Business Mailing Address Fax Number:
937-293-0969

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 MEDICAL CENTER DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRANKLIN
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45005-2584
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-420-5755
Provider Business Practice Location Address Fax Number:
937-293-0969
Provider Enumeration Date:
11/05/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SEITZMAN
Authorized Official First Name:
HOWARD
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
937-478-3030

Provider Taxonomy Codes

  • Taxonomy code: 207LP2900X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)