Healthcare Provider Details

I. General information

NPI: 1225942766
Provider Name (Legal Business Name): PREMIUM MANAGEMENT VI LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 PEBBLECREEK DR
HARVEST AL
35749-9237
US

IV. Provider business mailing address

102 PEBBLECREEK DR
HARVEST AL
35749-9237
US

V. Phone/Fax

Practice location:
  • Phone: 205-201-1060
  • Fax:
Mailing address:
  • Phone: 256-483-9822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number StateNULL

VIII. Authorized Official

Name: KEDRA BELL
Title or Position: OWNER
Credential:
Phone: 205-201-1060