Provider Demographics
NPI:1316362106
Name:PRI MED PHYSICIANS, INC
Entity Type:Organization
Organization Name:PRI MED PHYSICIANS, INC
Other - Org Name:ALL MED AT DALRAIDA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:HERROD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-323-4000
Mailing Address - Street 1:100 CAPITOL COMMERCE BLVD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-4260
Mailing Address - Country:US
Mailing Address - Phone:334-323-4000
Mailing Address - Fax:334-386-1479
Practice Address - Street 1:4035 ATLANTA HWY
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36109-2920
Practice Address - Country:US
Practice Address - Phone:334-323-4000
Practice Address - Fax:334-386-1479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-03
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty