Organization
PREMIER INTEGRATED MEDICAL ASSOC LTD
Active
Other names
PriMed Physicians
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK A COUCH MD (PRESIDENT)
(937) 898-3600
Entity
Organization
Contact information
Practice address
2322 LAKEVIEW DR, BEAVERCREEK, OH 45431
(937) 320-3848
(937) 320-3848
Mailing address
25 MERCHANT ST, STE 220 - ATTN CREDENTIALING, CINCINNATI, OH 45246-3740
(513) 533-1199
(513) 645-9827
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
2080A0000X
Pediatric Adolescent Medicine Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2106232
—
OH
01
—
CA2478
MEDICARE RR ID
OH
Enumeration date
04/28/2006
Last updated
07/15/2019
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