MEDICARE: PREMIER HOSPITALIST SERVICES, LLC

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	207R00000X	Internal Medicine Physician
2	208M00000X	Hospitalist Physician

General Provider Information

NPI Number	:	1538475447
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIER HOSPITALIST SERVICES, LLC

Provider Business Mailing Address
First Line	:	50 MEDICAL PARK DR E
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35235-3401
Country	:	US
Telephone Number	:	205-545-9530
Fax Number	:	205-545-9529

Provider Business Practice Location Address
First Line	:	2016 STONEGATE TRL
Second Line	:	STE 112
City	:	VESTAVIA HILLS
State	:	AL
Zip	:	35242-2260
Country	:	US
Telephone Number	:	205-545-9530
Fax Number	:	205-545-9529

Authorized Official
Title or Position	:	ADMINSTRATOR
Name	:	MR. RANDY HAMMOND
Credential	:
Telephone Number	:	205-545-9530

Provider Enumeration Date	:	08/30/2010
Last Update Date	:	08/30/2010

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