Healthcare Provider Details

I. General information

NPI: 1528588795
Provider Name (Legal Business Name): PREMIER DIAGNOSTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2017
Last Update Date: 09/02/2025
Certification Date: 06/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3838 OAK LAWN AVE STE 1420
DALLAS TX
75219-4515
US

IV. Provider business mailing address

3838 OAK LAWN AVE STE 1420
DALLAS TX
75219-4515
US

V. Phone/Fax

Practice location:
  • Phone: 888-482-2334
  • Fax:
Mailing address:
  • Phone: 888-482-2334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204R00000X
TaxonomyElectrodiagnostic Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code246ZE0500X
TaxonomyEEG Specialist/Technologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number State

VIII. Authorized Official

Name: KENNETH WEATHERWAX
Title or Position: DIRECTOR
Credential:
Phone: 469-646-8663