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	:	1609959261
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRI MED PHYSICIANS INC

Provider Business Mailing Address
First Line	:	8401 CROSSLAND LOOP
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36117-8485
Country	:	US
Telephone Number	:	334-386-1420
Fax Number	:	334-386-1479

Provider Business Practice Location Address
First Line	:	4452 US HIGHWAY 231
Second Line	:
City	:	WETUMPKA
State	:	AL
Zip	:	36092-3328
Country	:	US
Telephone Number	:	334-567-8400
Fax Number	:	334-567-8188

Authorized Official
Title or Position	:	COO
Name	:	HEIDE GARNER COOK
Credential	:
Telephone Number	:	334-386-1444

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	08/22/2020

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Directions to “PRI MED PHYSICIANS INC ” Practice Location

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