Provider Demographics
NPI:1831493675
Name:PREMIER FAMILY CARE, LLC
Entity Type:Organization
Organization Name:PREMIER FAMILY CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESS
Authorized Official - Middle Name:H
Authorized Official - Last Name:YOUNGBLOOD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-582-2324
Mailing Address - Street 1:2017 OBRIG AVE
Mailing Address - Street 2:
Mailing Address - City:GUNTERSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35976-2156
Mailing Address - Country:US
Mailing Address - Phone:256-582-2324
Mailing Address - Fax:256-582-2321
Practice Address - Street 1:2017 OBRIG AVE
Practice Address - Street 2:
Practice Address - City:GUNTERSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35976-2156
Practice Address - Country:US
Practice Address - Phone:256-582-2324
Practice Address - Fax:256-582-2321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-10
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALC72870Medicare UPIN