Basic Information
| Provider Information | |||||||||
| NPI: | 1790708741 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PREMIER HEALTH ASSOCIATES INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 8002 | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | NH | ||||||||
| PostalCode: | 030798002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8009270035 | ||||||||
| FaxNumber: | 6038901236 | ||||||||
| Practice Location | |||||||||
| Address1: | 22792 HARRISBURG WESTVILLE RD | ||||||||
| Address2: | |||||||||
| City: | ALLIANCE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 446019224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3308234000 | ||||||||
| FaxNumber: | 3308292919 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2006 | ||||||||
| LastUpdateDate: | 11/14/2016 | ||||||||
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| AuthorizedOfficialLastName: | AHMED | ||||||||
| AuthorizedOfficialFirstName: | MICHELLE | ||||||||
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| AuthorizedOfficialTitleorPosition: | SHAREHOLDER | ||||||||
| AuthorizedOfficialTelephone: | 3308234000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2286057 | 05 | OH | MEDICAID |