Provider Demographics
NPI:1073568036
Name:PREMIER HEALTH MANAGEMENT, INC.
Entity Type:Organization
Organization Name:PREMIER HEALTH MANAGEMENT, INC.
Other - Org Name:PREMIER MEDICAL MANAGEMENT INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:W
Authorized Official - Last Name:HARTMAN
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:251-473-1900
Mailing Address - Street 1:2880 DAUPHIN ST
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36606-2457
Mailing Address - Country:US
Mailing Address - Phone:251-473-1900
Mailing Address - Fax:
Practice Address - Street 1:5 MEDICAL PARK
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-1873
Practice Address - Country:US
Practice Address - Phone:251-928-2302
Practice Address - Fax:251-928-2308
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PREMIER MEDICAL MANAGEMENT INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-24
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1156150003Medicare NSC