Healthcare Provider Details

I. General information

NPI: 1609093327
Provider Name (Legal Business Name): PREMIER DIAGNOSTIC SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 FLEMING DR
HARTS WV
25524-9788
US

IV. Provider business mailing address

22 FLEMING DR
HARTS WV
25524-9788
US

V. Phone/Fax

Practice location:
  • Phone: 304-855-4595
  • Fax:
Mailing address:
  • Phone: 304-855-4595
  • Fax:

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: MARK YOUNIS
Title or Position: PARTNER
Credential: MD
Phone: 304-855-4595