Provider Demographics
NPI:1902672124
Name:PREMIERE MEDICAL COMPANY, INC.
Entity Type:Organization
Organization Name:PREMIERE MEDICAL COMPANY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BIVINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-353-9918
Mailing Address - Street 1:1290 KENNESTONE CIR BLDG A101-A
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-6009
Mailing Address - Country:US
Mailing Address - Phone:770-353-9918
Mailing Address - Fax:
Practice Address - Street 1:1290 KENNESTONE CIR BLDG A101-A
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-6009
Practice Address - Country:US
Practice Address - Phone:770-353-9918
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-29
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies