Provider Demographics
NPI:1467535021
Name:PRI MED PHYSICIANS INC
Entity Type:Organization
Organization Name:PRI MED PHYSICIANS INC
Other - Org Name:PRI MED TAYLOR CROSSING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:HEIDE
Authorized Official - Middle Name:
Authorized Official - Last Name:GARNER COOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-386-1444
Mailing Address - Street 1:8401 CROSSLAND LOOP
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-8485
Mailing Address - Country:US
Mailing Address - Phone:334-386-1420
Mailing Address - Fax:334-386-1479
Practice Address - Street 1:34 TAYLOR RD N
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-6753
Practice Address - Country:US
Practice Address - Phone:334-272-7639
Practice Address - Fax:334-272-5170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALK583Medicare ID - Type Unspecified