Provider Demographics
NPI:1043263643
Name:PREMIER HEALTH SPECIALISTS INC
Entity type:Organization
Organization Name:PREMIER HEALTH SPECIALISTS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:DANIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-435-4263
Mailing Address - Street 1:30 E APPLE ST
Mailing Address - Street 2:STE 6258
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45409-2939
Mailing Address - Country:US
Mailing Address - Phone:937-208-5300
Mailing Address - Fax:937-208-5650
Practice Address - Street 1:30 E APPLE ST
Practice Address - Street 2:STE 6258
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45409-2939
Practice Address - Country:US
Practice Address - Phone:937-208-5300
Practice Address - Fax:937-208-5650
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PREMIER HEALTH SPECIALISTS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-18
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2633725Medicaid
OH9353865Medicare PIN