Provider Demographics
NPI:1639683378
Name:AMG PREMIRE, INC.
Entity Type:Organization
Organization Name:AMG PREMIRE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:HANNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-740-3217
Mailing Address - Street 1:600 N MOUNTAIN AVE STE C201
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-4367
Mailing Address - Country:US
Mailing Address - Phone:909-740-3217
Mailing Address - Fax:888-636-4512
Practice Address - Street 1:600 N MOUNTAIN AVE STE C201
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-4367
Practice Address - Country:US
Practice Address - Phone:909-740-3217
Practice Address - Fax:888-636-4512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-16
Last Update Date:2017-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CATCP0037598-P343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)