NPIMap

Organization Active NPI

Premier Mastectomy Vendor LLC

  • Mastectomy Fitter
  • Montgomery, AL
National Provider Identifier
1699458380
Registry record updated Dec 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mastectomy FitterTaxonomy code 224900000X
Legal business name
PREMIER MASTECTOMY VENDOR LLC
Practice address
5911 Monticello Dr Ste B
Montgomery, AL 36117-1940
Phone
(629) 279-5720
NPI assigned
Aug 9, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 20, 2023

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

Authorized official

Name
Ms. Jasmine Bean
Title
Co-Owner
Phone
(629) 279-5270

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mastectomy FitterGroup: 193200000X MULTI-SPECIALTY GROUP 224900000X Primary
Massage TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225700000X

Addresses

Primary practice location

5911 Monticello Dr Ste B
Montgomery, AL 36117-1940

Mailing address

5911 Monticello Dr Ste B
Montgomery, AL 36117-1940
Phone (629) 279-5720

National Provider Directory

National Provider Directory

Locations

5911 Monticello Dr
Ste B
Montgomery, AL 36117
Phone (334) 676-2797

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1691539200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1703030400000",
    "number": "1699458380",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5911 MONTICELLO DR STE B",
            "city": "MONTGOMERY",
            "state": "AL",
            "postal_code": "361171940",
            "telephone_number": "629-279-5720"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5911 MONTICELLO DR STE B",
            "city": "MONTGOMERY",
            "state": "AL",
            "postal_code": "361171940",
            "telephone_number": "629-279-5720"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER MASTECTOMY VENDOR LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-08-09",
        "last_updated": "2023-12-20",
        "certification_date": "2023-12-20",
        "status": "A",
        "authorized_official_last_name": "BEAN",
        "authorized_official_first_name": "JASMINE",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "629-279-5270",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "224900000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Mastectomy Fitter",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "225700000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Massage Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Montgomery, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.