Basic Information
| Provider Information | |||||||||
| NPI: | 1023358280 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PREMIER HEALTH AND WELLNESS CENTER, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2823 AARONWOOD AVE NE | ||||||||
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| City: | MASSILLON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 446462371 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3308308666 | ||||||||
| FaxNumber: | 3308323499 | ||||||||
| Practice Location | |||||||||
| Address1: | 4774 MUNSON ST NW | ||||||||
| Address2: | |||||||||
| City: | CANTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 447183634 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3307544431 | ||||||||
| FaxNumber: | 3307775499 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/26/2013 | ||||||||
| LastUpdateDate: | 02/26/2013 | ||||||||
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| AuthorizedOfficialLastName: | MCCLAIN | ||||||||
| AuthorizedOfficialFirstName: | BRIAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3308308666 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 35.077014 | OH | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.