| Premium Family Care Llc | |
|
333 Whitesport Dr Sw Ste 204 Huntsville AL 35801-3455 | |
| (601) 566-3564 | |
| Not Available |
| Full Name | Premium Family Care Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 333 Whitesport Dr Sw Ste 204, Huntsville, Alabama |
| Authorized Official Name and Position | Jacob Wilson (OWNER) |
| Authorized Official Contact | 6015290948 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Premium Family Care Llc 333 Whitesport Dr Sw Ste 204 Huntsville AL 35801-3455 Ph: (601) 566-3564 | Premium Family Care Llc 333 Whitesport Dr Sw Ste 204 Huntsville AL 35801-3455 Ph: (601) 566-3564 |
| NPI Number | 1922667476 |
|---|---|
| Provider Enumeration Date | 06/09/2019 |
| Last Update Date | 06/09/2019 |
| Medicare PECOS PAC ID | 1759610041 |
|---|---|
| Medicare Enrollment ID | O20190911003574 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922667476 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Jacob Nathaniel Wilson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1396192423 PECOS PAC ID: 1456605773 Enrollment ID: I20181126001040 |
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