NPIMap

Organization Active NPI

Premier Physicians Centers, Inc.

  • Family Medicine Physician
  • Lakewood, OH
National Provider Identifier
1073552329
Registry record updated Feb 4, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
PREMIER PHYSICIANS CENTERS, INC.
Practice address
14600 Detroit Ave
Suite 103
Lakewood, OH 44107-4207
Phone
(216) 227-0717
Fax
(216) 227-0827
NPI assigned
Jun 5, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 4, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Mark E Wiedt
Title
Chief Executive Officer
Phone
(440) 895-5021

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

14600 Detroit Ave
Suite 103
Lakewood, OH 44107-4207

Mailing address

20525 Center Ridge Rd
Suite 220
Rocky River, OH 44116-3437
Phone (440) 895-5021

National Provider Directory

National Provider Directory
Tax ID family
Lakewood Hospital Professional Services5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

20525 Center Ridge Rd
Ste 220
Rocky River, OH 44116
Phone (440) 895-5021

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1149465600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1265241600000",
    "number": "1073552329",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20525 CENTER RIDGE RD",
            "address_2": "SUITE 220",
            "city": "ROCKY RIVER",
            "state": "OH",
            "postal_code": "441163437",
            "telephone_number": "440-895-5021",
            "fax_number": "440-895-5050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14600 DETROIT AVE",
            "address_2": "SUITE 103",
            "city": "LAKEWOOD",
            "state": "OH",
            "postal_code": "441074207",
            "telephone_number": "216-227-0717",
            "fax_number": "216-227-0827"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER PHYSICIANS CENTERS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-05",
        "last_updated": "2010-02-04",
        "status": "A",
        "authorized_official_last_name": "WIEDT",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "440-895-5021",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lakewood, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.