Provider Demographics
NPI:1063740785
Name:PREMIERE WOMEN'S CENTER
Entity type:Organization
Organization Name:PREMIERE WOMEN'S CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED NURSE
Authorized Official - Prefix:
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:
Authorized Official - Last Name:LAKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-985-0950
Mailing Address - Street 1:8261 CORNELL RD
Mailing Address - Street 2:SUITE 610-B
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45249-2278
Mailing Address - Country:US
Mailing Address - Phone:513-985-0950
Mailing Address - Fax:513-792-5191
Practice Address - Street 1:8261 CORNELL RD
Practice Address - Street 2:SUITE 610-B
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45249-2278
Practice Address - Country:US
Practice Address - Phone:513-985-0950
Practice Address - Fax:513-792-5191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-19
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty