Provider Demographics
NPI:1851375885
Name:PREMIER MEDICAL
Entity Type:Organization
Organization Name:PREMIER MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMMOND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-545-9530
Mailing Address - Street 1:2016 STONEGATE TRAIL
Mailing Address - Street 2:SUITE 112
Mailing Address - City:VESTAVIA HILLS
Mailing Address - State:AL
Mailing Address - Zip Code:35244-2260
Mailing Address - Country:US
Mailing Address - Phone:205-545-9530
Mailing Address - Fax:205-545-9529
Practice Address - Street 1:50 MEDICAL PARK EAST DR
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35235
Practice Address - Country:US
Practice Address - Phone:205-545-9530
Practice Address - Fax:205-545-9530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-02
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL351890800OtherDEPT OF LABOR
AL529910000Medicaid
ALC141OtherBCBS
ALCH5239OtherRAILROAD MEDICARE
AL529905830Medicaid
AL529910000Medicaid