Organization
PREMIER MASTECTOMY VENDOR LLC
Active
Organization
PREMIER MASTECTOMY VENDOR LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JASMINE BEAN (CO-OWNER)
(629) 279-5270
Entity
Organization
Contact information
Practice address
5911 MONTICELLO DR STE B, MONTGOMERY, AL 36117-1940
(629) 279-5720
Mailing address
5911 MONTICELLO DR STE B, MONTGOMERY, AL 36117-1940
(629) 279-5720
Taxonomy
Speciality
Code
Description
License number
State
224900000X
Mastectomy Fitter
Primary
—
—
225700000X
Massage Therapist
—
—
Other
Enumeration date
08/09/2023
Last updated
12/20/2023
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