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General NPI Number Information
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NPI Number | 1285633370
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Entity Type | Organization
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Legal Business Name | PREMIER IMAGING AND INTERVENTION, PLLC
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Dates
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Enumeration Date | 07/20/2005
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Last Update Date | 08/26/2014
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Provider Practice Location Address
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Address Line | 122 PINNELL ST # 720
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City | RIPLEY
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State | WV
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Zip | 25271-9101
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Country | US
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Telephone | 866-871-7843
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Fax | 614-764-9147
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Provider Business Mailing Address
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Address Line | PO BOX 11795 L-2543
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City | CHARLESTON
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State | WV
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Zip | 25339-1795
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Country | US
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Telephone | 866-871-7843
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Fax | 614-764-9147
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARK YOUNIS
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Credential | MD
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Telephone | 304-372-2731
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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