Provider Demographics
NPI:1629452123
Name:PRESTIGE MEDICAL LLC
Entity Type:Organization
Organization Name:PRESTIGE MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-341-7295
Mailing Address - Street 1:103 S NAVY BLVD
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32507-3603
Mailing Address - Country:US
Mailing Address - Phone:850-361-1502
Mailing Address - Fax:850-361-1503
Practice Address - Street 1:857 DOWNTOWNER BLVD STE G
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36609-5420
Practice Address - Country:US
Practice Address - Phone:251-341-7295
Practice Address - Fax:251-341-7690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-14
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center