Organization
PREMIER PHYSICIANS CENTERS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES MICA (COO)
(440) 895-5057
Entity
Organization
Contact information
Practice address
24500 CENTER RIDGE RD STE 375, WESTLAKE, OH 44145-5631
(440) 895-5057
(440) 895-5050
Mailing address
PO BOX 639004, CINCINNATI, OH 45263-0002
(440) 895-5010
(440) 895-5050
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
207RC0000X
Cardiovascular Disease Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0119204
—
OH
01
—
CA4511
RR MEDICARE GROUP
—
Enumeration date
05/12/2006
Last updated
03/26/2021
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