Healthcare Provider Details

I. General information

NPI: 1134121601
Provider Name (Legal Business Name): PREMIER HEALTH SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2005
Last Update Date: 07/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1154 N MAIN ST
ALGONQUIN IL
60102-3482
US

IV. Provider business mailing address

1154 N MAIN ST
ALGONQUIN IL
60102-3482
US

V. Phone/Fax

Practice location:
  • Phone: 847-458-1460
  • Fax: 847-458-1942
Mailing address:
  • Phone: 847-458-1460
  • Fax: 847-458-1942

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ELISE KALISCH
Title or Position: REGIONAL DIRECTOR OF OPS
Credential:
Phone: 847-228-0834