Healthcare Provider Details

I. General information

NPI: 1649867771
Provider Name (Legal Business Name): PREMIER ULTRASOUND, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2020
Last Update Date: 12/22/2020
Certification Date: 12/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1121 UNIVERSITY BLVD W APT 815
SILVER SPRING MD
20902-3320
US

IV. Provider business mailing address

PO BOX 1978
SILVER SPRING MD
20915-1978
US

V. Phone/Fax

Practice location:
  • Phone: 443-801-6754
  • Fax:
Mailing address:
  • Phone: 443-801-6754
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code335V00000X
TaxonomyPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
License Number
License Number State

VIII. Authorized Official

Name: MRS. TEHILA HOLZER
Title or Position: CEO
Credential:
Phone: 443-801-6754