Provider Demographics
NPI:1871346940
Name:PREMIER MEDICAL., LLC
Entity type:Organization
Organization Name:PREMIER MEDICAL., LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUMMER
Authorized Official - Middle Name:PAIGE
Authorized Official - Last Name:SLATER
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:256-533-4645
Mailing Address - Street 1:250 CHATEAU DR SW STE 115
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-3497
Mailing Address - Country:US
Mailing Address - Phone:256-533-4645
Mailing Address - Fax:256-808-3178
Practice Address - Street 1:250 CHATEAU DR SW STE 115
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-3497
Practice Address - Country:US
Practice Address - Phone:256-533-4645
Practice Address - Fax:256-808-3178
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PREMIER MEDICAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-04-09
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL188348Medicaid