Provider Demographics
NPI:1205187663
Name:PREMIER ORTHOPEDIC SURGERY, INC
Entity Type:Organization
Organization Name:PREMIER ORTHOPEDIC SURGERY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:P
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:256-571-8445
Mailing Address - Street 1:7938 AL HWY 69
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GUNTERSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35976-7119
Mailing Address - Country:US
Mailing Address - Phone:256-571-8445
Mailing Address - Fax:256-571-8447
Practice Address - Street 1:2367 US HIGHWAY 431
Practice Address - Street 2:
Practice Address - City:BOAZ
Practice Address - State:AL
Practice Address - Zip Code:35957-5910
Practice Address - Country:US
Practice Address - Phone:256-571-8445
Practice Address - Fax:256-571-8447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-26
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009938489Medicaid
AL51003891OtherBCBS OF AL
AL009938489Medicaid