Healthcare Provider Details

I. General information

NPI: 1346670239
Provider Name (Legal Business Name): PREMIER DIAGNOSTIC SERVICES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2013
Last Update Date: 11/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

391 EAST BROWN STREET
EAST STROUDSBURG PA
18301
US

IV. Provider business mailing address

391 EAST BROWN STREET
EAST STROUDSBURG PA
18301
US

V. Phone/Fax

Practice location:
  • Phone: 570-241-9224
  • Fax: 570-872-9888
Mailing address:
  • Phone: 570-241-9224
  • Fax: 570-872-9888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD424898
License Number StatePA

VIII. Authorized Official

Name: MIKHAIL ARTAMONOV
Title or Position: OWNER/ PRESIDENT
Credential: MD
Phone: 570-241-9224