NPIMap

Organization Active NPI

Premier Medical Clinic LLC

  • Multi-Specialty Clinic/Center
  • Scottsboro, AL
National Provider Identifier
1083955173
Registry record updated Jul 14, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
PREMIER MEDICAL CLINIC LLC
Practice address
503 Burlington Street
Scottsboro, AL 35768
Phone
(256) 259-1886
NPI assigned
Mar 14, 2013
Last updated
Jul 14, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 14, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Muhammad Ata, MD
Title
Owner
Phone
(256) 451-1250

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X AL Primary
Rural Health Clinic/Center 261QR1300X NU

Addresses

Primary practice location

503 Burlington Street
Scottsboro, AL 35768

Mailing address

PO Box 56
Scottsboro, AL 35768
Phone (256) 259-1886

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20130520000728 AL Part B Supplier - Clinic/Group Practice 7012155609 Receives reassigned benefits from 21 practitioners
Practice locations: Scottsboro, AL
O20130523000355 AL Part A Provider - Rural Health Clinic 7012155609 Practice locations: Scottsboro, AL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1083955173. Details of each certification follow.

Rural health clinic certification: CCN 018906

Legal name
PREMIER MEDICAL CLINIC LLC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Aug 9, 2013
Last certification
Aug 9, 2013
Ownership / control type
1B
Organization structure
LLCProprietary
Incorporated
Mar 8, 2013 in AL
Enrollment address
506 Harley St
Scottsboro, AL 35768-4219

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
01D2055996Premier Medical Clinic LLC506 Harley Street, Scottsboro, AL 35768Certificate of waiverMar 19, 2027

National Provider Directory

National Provider Directory

Locations

503 Burlington St
Scottsboro, AL 35768
Phone (256) 259-1886

Ownership & related parties

All disclosed owners & managing parties 1

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Muhammad Ata Individual 5% Or Greater Direct Ownership Interest Mar 23, 2013
Limited Partnership Interest Mar 23, 2013
W-2 Managing Employee Mar 23, 2013

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

  • Muhammad Ejaz Ata
    • Internal Medicine Physician
    • Pisgah, AL
    • NPI 1023112307

    5% Or Greater Direct Ownership Interest, Limited Partnership Interest, W-2 Managing Employee

    CMS ownership

Practitioners & affiliated clinicians

Practitioners 21

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 21

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1363219200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1752451200000",
    "number": "1083955173",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 56",
            "city": "SCOTTSBORO",
            "state": "AL",
            "postal_code": "35768",
            "telephone_number": "256-259-1886"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "503 BURLINGTON STREET",
            "city": "SCOTTSBORO",
            "state": "AL",
            "postal_code": "35768",
            "telephone_number": "256-259-1886"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER MEDICAL CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-03-14",
        "last_updated": "2025-07-14",
        "certification_date": "2025-07-14",
        "status": "A",
        "authorized_official_last_name": "ATA",
        "authorized_official_first_name": "MUHAMMAD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "256-451-1250",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "AL",
            "license": null,
            "primary": true
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Scottsboro, AL

Sources for this page

Verify at the official NPI Registry.