Healthcare Provider Details

I. General information

NPI: 1659351963
Provider Name (Legal Business Name): PREMIER IMAGING GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 S TAFT AVE
FREMONT OH
43420-3200
US

IV. Provider business mailing address

PO BOX 1524
LIMA OH
45802-1524
US

V. Phone/Fax

Practice location:
  • Phone: 419-332-7321
  • Fax:
Mailing address:
  • Phone: 419-224-5707
  • Fax: 419-229-0040

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: ROBIN E OSBORN
Title or Position: PRESIDENT
Credential: D.O.
Phone: 937-398-0503