Provider Demographics
NPI:1487677894
Name:PREMIERE MEDICAL ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:PREMIERE MEDICAL ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOREEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:VINCENT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:615-867-1602
Mailing Address - Street 1:PO BOX 332505
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37133-2505
Mailing Address - Country:US
Mailing Address - Phone:615-867-1602
Mailing Address - Fax:615-867-1611
Practice Address - Street 1:522B BRANDIES CIR
Practice Address - Street 2:SUITE 2
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37128-4872
Practice Address - Country:US
Practice Address - Phone:615-867-1602
Practice Address - Fax:615-867-1611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDO7163207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty