Provider Demographics
NPI:1932711132
Name:PREMIER FAMILY CARE BLOUNTSVILLE, LLC
Entity type:Organization
Organization Name:PREMIER FAMILY CARE BLOUNTSVILLE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:HARPER
Authorized Official - Suffix:
Authorized Official - Credentials:OFFICE MANAGER
Authorized Official - Phone:256-586-2324
Mailing Address - Street 1:68278 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BLOUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35031-3370
Mailing Address - Country:US
Mailing Address - Phone:256-586-2324
Mailing Address - Fax:256-586-2321
Practice Address - Street 1:68278 MAIN ST
Practice Address - Street 2:
Practice Address - City:BLOUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35031-3370
Practice Address - Country:US
Practice Address - Phone:256-586-2324
Practice Address - Fax:256-586-2321
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PREMIER FAMILY CARE BLOUNTSVILLE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-08-19
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty