Provider Demographics
NPI:1992774392
Name:PREMIER HEALTH MANAGEMENT, INC.
Entity type:Organization
Organization Name:PREMIER HEALTH MANAGEMENT, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:L
Authorized Official - Last Name:SPIRES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-341-3368
Mailing Address - Street 1:2880 DAUPHIN ST
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36606-2457
Mailing Address - Country:US
Mailing Address - Phone:251-473-1900
Mailing Address - Fax:
Practice Address - Street 1:1206 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:AL
Practice Address - Zip Code:36545-2407
Practice Address - Country:US
Practice Address - Phone:251-246-3231
Practice Address - Fax:251-246-3034
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PREMIER HEALTH MANAGEMENT INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-03-16
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL244332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1156150002Medicare NSC