Healthcare Provider Details

I. General information

NPI: 1265515811
Provider Name (Legal Business Name): PRI MED PHYSICIANS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 07/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1595 E MAIN ST
PRATTVILLE AL
36066-5509
US

IV. Provider business mailing address

8401 CROSSLAND LOOP
MONTGOMERY AL
36117-8485
US

V. Phone/Fax

Practice location:
  • Phone: 334-361-3171
  • Fax: 334-361-3176
Mailing address:
  • Phone: 334-386-1420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: HEIDE GARNER COOK
Title or Position: COO
Credential:
Phone: 334-386-1444