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General NPI Number Information
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NPI Number | 1528588795
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Entity Type | Organization
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Legal Business Name | PREMIER DIAGNOSTICS LLC
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Dates
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Enumeration Date | 06/20/2017
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Last Update Date | 09/02/2025
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Provider Practice Location Address
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Address Line | 3838 OAK LAWN AVE STE 1420
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City | DALLAS
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State | TX
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Zip | 75219-4515
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Country | US
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Telephone | 888-482-2334
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Fax |
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Provider Business Mailing Address
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Address Line | 3838 OAK LAWN AVE STE 1420
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City | DALLAS
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State | TX
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Zip | 75219-4515
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Country | US
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Telephone | 888-482-2334
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | KENNETH WEATHERWAX
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Credential |
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Telephone | 469-646-8663
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204R00000X
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Taxonomy Name | Electrodiagnostic Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 246ZE0500X
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Taxonomy Name | EEG Specialist/Technologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 293D00000X
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Taxonomy Name | Physiological Laboratory
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License Number |
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License Number State |
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