MEDICARE: PREMIER IMAGING SOLUTIONS NORCAL LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	335V00000X	Portable X-ray and/or Other Portable Diagnostic Imaging Supplier

General Provider Information

NPI Number	:	1891470977
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIER IMAGING SOLUTIONS NORCAL LLC

Provider Business Mailing Address
First Line	:	3440 N 16TH ST STE 200
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85016-7125
Country	:	US
Telephone Number	:	605-484-0188
Fax Number	:

Provider Business Practice Location Address
First Line	:	4630 NORTHGATE BLVD STE 150
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95834-1141
Country	:	US
Telephone Number	:	877-211-4523
Fax Number	:

Authorized Official
Title or Position	:	QUALITY AND COMPLIANCE DIRECTOR
Name	:	MR. JAMIE WOOD
Credential	:
Telephone Number	:	605-484-0188

Provider Enumeration Date	:	06/16/2023
Last Update Date	:	06/16/2023

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