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General NPI Number Information
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NPI Number | 1578128963
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Entity Type | Organization
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Legal Business Name | PREMIER MOBILE IMAGING, LLC
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Dates
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Enumeration Date | 05/01/2019
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Last Update Date | 05/01/2019
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Provider Practice Location Address
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Address Line | 6323 QUAILEY DR SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-7113
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Country | US
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Telephone | 812-219-6562
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Fax |
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Provider Business Mailing Address
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Address Line | 6323 QUAILEY DR SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-7113
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Country | US
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Telephone | 812-219-6562
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | CHRISTOPHER REESE JOHNSON
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Credential |
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Telephone | 812-219-6562
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246XS1301X
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Taxonomy Name | Sonography Specialist/Technologist Cardiovascular
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License Number |
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License Number State |
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