MEDICARE: PRI MED PHYSICIANS, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1316362106
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRI MED PHYSICIANS, INC

Provider Business Mailing Address
First Line	:	100 CAPITOL COMMERCE BLVD
Second Line	:	SUITE 250
City	:	MONTGOMERY
State	:	AL
Zip	:	36117-4260
Country	:	US
Telephone Number	:	334-323-4000
Fax Number	:	334-386-1479

Provider Business Practice Location Address
First Line	:	4035 ATLANTA HWY
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36109-2920
Country	:	US
Telephone Number	:	334-323-4000
Fax Number	:	334-386-1479

Authorized Official
Title or Position	:	CEO/OWNER
Name	:	MR. JOSEPH HERROD
Credential	:
Telephone Number	:	334-323-4000

Provider Enumeration Date	:	03/03/2014
Last Update Date	:	03/03/2014

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