Provider Demographics
NPI:1689627572
Name:PREMIER ORTHOPEDIC SURGERY, INC.
Entity Type:Organization
Organization Name:PREMIER ORTHOPEDIC SURGERY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:256-505-7066
Mailing Address - Street 1:7938 AL HWY 69
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GUNTERSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35976-7119
Mailing Address - Country:US
Mailing Address - Phone:256-571-8445
Mailing Address - Fax:256-571-8447
Practice Address - Street 1:7938 AL HWY 69
Practice Address - Street 2:SUITE 100
Practice Address - City:GUNTERSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35976
Practice Address - Country:US
Practice Address - Phone:256-571-8445
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALDO930207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009938489Medicaid
AL1336193440OtherINDIVIDUAL NPI
AL1689627572OtherGROUP NPI
AL009938491Medicaid
1225573629OtherNPI
AL009938491Medicaid
AL009938489Medicaid