Healthcare Provider Details

I. General information

NPI: 1144576398
Provider Name (Legal Business Name): PRIMED PHYSICIANS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2012
Last Update Date: 07/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7065 SYDNEY CURV
MONTGOMERY AL
36117-3509
US

IV. Provider business mailing address

100 CAPITOL COMMERCE BLVD STE 250
MONTGOMERY AL
36117-4260
US

V. Phone/Fax

Practice location:
  • Phone: 334-323-4000
  • Fax: 334-386-1478
Mailing address:
  • Phone: 334-386-1420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DONALD BROBST
Title or Position: OWNER/PHYSICIAN
Credential: MD
Phone: 334-386-1420