MEDICARE: PREMIER DIAGNOSTIC SERVICES, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	246W00000X	Cardiology Technician
2	246XS1301X	Sonography Specialist/Technologist Cardiovascular
3	246ZE0500X	EEG Specialist/Technologist
4	2471B0102X	Bone Densitometry Radiologic Technologist
5	2471V0105X	Vascular Sonography Radiologic Technologist
6	2471S1302X	Sonography Radiologic Technologist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	76Y00737NH01	OTHER	NH	NH ANTHEM BC PROV
4	041169	OTHER	MA	BCMA IPDL#
5	327019	OTHER	MA	MA BC PROV

General Provider Information

NPI Number	:	1659377802
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIER DIAGNOSTIC SERVICES, INC

Provider Business Mailing Address
First Line	:	378 PAGE ST.
Second Line	:	SUITE 101
City	:	STOUGHTON
State	:	MA
Zip	:	02072-1124
Country	:	US
Telephone Number	:	800-346-2111
Fax Number	:	508-584-6362

Provider Business Practice Location Address
First Line	:	378 PAGE ST.
Second Line	:	SUITE 101
City	:	STOUGHTON
State	:	MA
Zip	:	02072-1124
Country	:	US
Telephone Number	:	800-346-2111
Fax Number	:	508-584-6362

Authorized Official
Title or Position	:	VP
Name	:	MR. BRYON L BECKER
Credential	:
Telephone Number	:	508-584-5600

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	03/20/2023

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Directions to “PREMIER DIAGNOSTIC SERVICES, INC ” Practice Location

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