Provider Demographics
NPI:1083669121
Name:PREMIER RADIOLOGY, INC
Entity Type:Organization
Organization Name:PREMIER RADIOLOGY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:CARLTON
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:662-620-7102
Mailing Address - Street 1:620 CROSSOVER RD
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-4944
Mailing Address - Country:US
Mailing Address - Phone:662-842-1758
Mailing Address - Fax:662-844-8298
Practice Address - Street 1:620 CROSSOVER ROAD
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801
Practice Address - Country:US
Practice Address - Phone:662-620-7101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL2954OtherMEDICARE
MSCE6077OtherRAILROAD MEDICARE
MS9011191Medicaid
AL529700060Medicaid
MS=========OtherBLUE CROSS BLUE SHIELD
MSCE6077OtherRAILROAD MEDICARE
ALK749Medicare PIN
MSC00243Medicare PIN