Healthcare Provider Details

I. General information

NPI: 1285633370
Provider Name (Legal Business Name): PREMIER IMAGING AND INTERVENTION, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 08/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 PINNELL ST # 720
RIPLEY WV
25271-9101
US

IV. Provider business mailing address

PO BOX 11795 L-2543
CHARLESTON WV
25339-1795
US

V. Phone/Fax

Practice location:
  • Phone: 866-871-7843
  • Fax: 614-764-9147
Mailing address:
  • Phone: 866-871-7843
  • Fax: 614-764-9147

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: PRESIDENT
Credential: MD
Phone: 304-372-2731