Provider Demographics
NPI:1558314666
Name:PREMIER HEALTH MANAGEMENT, INC.
Entity Type:Organization
Organization Name:PREMIER HEALTH MANAGEMENT, INC.
Other - Org Name:PREMIER OPTICAL THOMASVILLE
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 1:126 ALABAMA AVE W
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:AL
Practice Address - Zip Code:36784-3100
Practice Address - Country:US
Practice Address - Phone:334-636-2529
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PREMIER HEALTH MANAGEMENT, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-18
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1156150006Medicare NSC