# PREMIERE SPINE AND SPORTS MEDICINE LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1336996131
- **Authorized official:** JENNIFER PEIFFER (OFFICE MANAGER)
- **Authorized official phone:** (301) 800-7770

## Contact information

- **Practice address:** 13114 PENNSYLVANIA AVENUE, WING B, HAGERSTOWN, MD 21742-8901
- **Practice address phone:** (301) 800-7770
- **Mailing address:** 13114 PENNSYLVANIA AVE, HAGERSTOWN, MD 21742-3720
- **Mailing address phone:** (301) 800-7770

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | NULL | Yes |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | — | Yes |

## Other

- **Enumeration date:** 05/01/2024
- **Last updated:** 06/20/2024