1285633370 NPI number — PREMIER IMAGING AND INTERVENTION, PLLC

Table of content: (NPI 1285633370)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285633370 NPI number — PREMIER IMAGING AND INTERVENTION, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PREMIER IMAGING AND INTERVENTION, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285633370
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/26/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 11795
Provider Second Line Business Mailing Address:
L-2543
Provider Business Mailing Address City Name:
CHARLESTON
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25339-1795
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-871-7843
Provider Business Mailing Address Fax Number:
614-764-9147

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
122 PINNELL ST # 720
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RIPLEY
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25271-9101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
866-871-7843
Provider Business Practice Location Address Fax Number:
614-764-9147
Provider Enumeration Date:
07/20/2005

Additional Information

Authorized Official

Authorized Official Last Name:
YOUNIS
Authorized Official First Name:
MARK
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
304-372-2731

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: DA1551 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 65939639 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 001707565 . This is a "BCBS" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 2694777 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3810007221 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000289222 . This is a "BCBS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 001906613 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3810003604 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0207230000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3810002570 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2649683 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: DA1021 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".




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