Provider Demographics
NPI:1053877506
Name:PREMIER MED PA
Entity type:Organization
Organization Name:PREMIER MED PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAUVID
Authorized Official - Middle Name:BEHRAM
Authorized Official - Last Name:AYADI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-352-2542
Mailing Address - Street 1:7512 DR PHILLIPS BLVD STE 50-344
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-5420
Mailing Address - Country:US
Mailing Address - Phone:407-543-6306
Mailing Address - Fax:
Practice Address - Street 1:2906 17TH ST.
Practice Address - Street 2:
Practice Address - City:ST CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34769
Practice Address - Country:US
Practice Address - Phone:407-543-6306
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-20
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty