1437406121 NPI number — PREMIER HEALTH MANAGEMENT, INC.

Table of content: (NPI 1437406121)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437406121 NPI number — PREMIER HEALTH MANAGEMENT, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PREMIER HEALTH MANAGEMENT, 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:
PREMIER OPTICAL DAPHNE
Provider Other Organization Name Type Code:
3
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:
1437406121
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/28/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2880 DAUPHIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOBILE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36606-2457
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
251-473-1900
Provider Business Mailing Address Fax Number:
251-470-8943

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7101 US HIGHWAY 90
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
DAPHNE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36526-9517
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
251-410-9000
Provider Business Practice Location Address Fax Number:
251-410-9200
Provider Enumeration Date:
08/13/2012

Additional Information

Authorized Official

Authorized Official Last Name:
HARTMAN
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
W
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
251-473-1900

Provider Taxonomy Codes

  • Taxonomy code: 332H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com