Healthcare Provider Details

I. General information

NPI: 1184302002
Provider Name (Legal Business Name): PREMIER MOUNTAIN IMAGING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2023
Last Update Date: 07/10/2023
Certification Date: 07/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5448 WHITE MOUNTAIN BLVD STE 110
LAKESIDE AZ
85929-5736
US

IV. Provider business mailing address

5448 WHITE MOUNTAIN BLVD STE 110
LAKESIDE AZ
85929-5736
US

V. Phone/Fax

Practice location:
  • Phone: 888-488-2702
  • Fax: 888-235-9876
Mailing address:
  • Phone: 888-488-2702
  • Fax: 888-235-9876

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. RAKESH PAHWA
Title or Position: OWNER
Credential:
Phone: 888-488-2702