Provider Demographics
NPI:1184970626
Name:PREMIER FAMILY & SPORTS MEDICINE, LLC
Entity type:Organization
Organization Name:PREMIER FAMILY & SPORTS MEDICINE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:LANGLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-581-9065
Mailing Address - Street 1:2940 MAGUIRE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-4751
Mailing Address - Country:US
Mailing Address - Phone:407-581-9065
Mailing Address - Fax:321-348-5827
Practice Address - Street 1:2940 MAGUIRE RD STE 200
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-4751
Practice Address - Country:US
Practice Address - Phone:407-581-9065
Practice Address - Fax:321-348-5827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-02
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME105459207QS0010X
FLME105078207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004227500Medicaid
FL004046500Medicaid
FL004227500Medicaid
FLF1858YMedicare UPIN