1821671041 NPI number — PREMIER URGENT CARE INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821671041 NPI number — PREMIER URGENT CARE INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PREMIER URGENT CARE INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1821671041
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/08/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5856 HIGHWAY 53 STE 200A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HARVEST
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35749-4305
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-858-1398
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2246 WINCHESTER RD NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUNTSVILLE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35811-6800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-929-4224
Provider Business Practice Location Address Fax Number:
888-498-4821
Provider Enumeration Date:
05/05/2021

Additional Information

Authorized Official

Authorized Official Last Name:
GREEN
Authorized Official First Name:
TESSE
Authorized Official Middle Name:
T
Authorized Official Title or Position:
OPERATIONS AND BILLING COORDINATOR
Authorized Official Telephone Number:
256-849-9197

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1356859391 . This is a "NPI" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 1427549823 . This is a "NPI" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 1437700606 . This is a "NPI" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 1659890945 . This is a "NPI" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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