Provider Demographics
NPI:1699929703
Name:PREMIER ORTHOPAEDICS AND SPORTS MEDICINE, LLC
Entity type:Organization
Organization Name:PREMIER ORTHOPAEDICS AND SPORTS MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MASOUD
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMIDIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-574-2663
Mailing Address - Street 1:380 WOODS COVE RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:SCOTTSBORO
Mailing Address - State:AL
Mailing Address - Zip Code:35768
Mailing Address - Country:US
Mailing Address - Phone:256-574-2663
Mailing Address - Fax:256-574-2664
Practice Address - Street 1:380 WOODS COVE RD
Practice Address - Street 2:SUITE A
Practice Address - City:SCOTTSBORO
Practice Address - State:AL
Practice Address - Zip Code:35768-2428
Practice Address - Country:US
Practice Address - Phone:256-574-2663
Practice Address - Fax:256-574-2664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-17
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD29131332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL6228760001Medicare NSC