Provider Demographics
NPI:1386708865
Name:E.P. PREMIER MEDICAL GROUP, P.A.
Entity type:Organization
Organization Name:E.P. PREMIER MEDICAL GROUP, P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SEYED
Authorized Official - Middle Name:M
Authorized Official - Last Name:ALAVI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:915-771-7200
Mailing Address - Street 1:6065 MONTANA AVE
Mailing Address - Street 2:SUITE A-2
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-1835
Mailing Address - Country:US
Mailing Address - Phone:915-771-7200
Mailing Address - Fax:915-771-7293
Practice Address - Street 1:6065 MONTANA AVE
Practice Address - Street 2:SUITE A-2
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-1835
Practice Address - Country:US
Practice Address - Phone:915-771-7200
Practice Address - Fax:915-771-7293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX207R00000X, 291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00U79ZMedicare ID - Type UnspecifiedMEDICARE GROUP