Healthcare Provider Details

I. General information

NPI: 1124933247
Provider Name (Legal Business Name): PREMIER RADIOLOGY SERVICES ILLINOIS S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

629A E HILLSBORO BLVD
DEERFIELD BEACH FL
33441-3517
US

IV. Provider business mailing address

629A E HILLSBORO BLVD
DEERFIELD BEACH FL
33441-3517
US

V. Phone/Fax

Practice location:
  • Phone: 866-957-1106
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: ROMINA D'ANDREA
Title or Position: CHIEF OPERATIONS OFFICER
Credential:
Phone: 908-230-9485