Basic Information
| Provider Information | |||||||||
| NPI: | 1427181387 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PREMIER MEDICAL CARE, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | PREMIUM MEDICAL CARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 789 | ||||||||
| Address2: | |||||||||
| City: | NORTH OLMSTED | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440700789 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4408992100 | ||||||||
| FaxNumber: | 4402500353 | ||||||||
| Practice Location | |||||||||
| Address1: | 1981 GRANVILLE PIKE | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | OH | ||||||||
| PostalCode: | 431301046 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7406549400 | ||||||||
| FaxNumber: | 7406549411 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/13/2007 | ||||||||
| LastUpdateDate: | 12/08/2008 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | LAKHI | ||||||||
| AuthorizedOfficialFirstName: | RANI | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6145751200 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QU0200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care |
ID Information
| ID | Type | State | Issuer | Description | 2730058 | 05 | OH | MEDICAID |