Provider Demographics
NPI:1114263134
Name:PREMIER DIAGNOSTICS OF VIRGINIA
Entity Type:Organization
Organization Name:PREMIER DIAGNOSTICS OF VIRGINIA
Other - Org Name:PREMIER CPAP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARVET
Authorized Official - Middle Name:L
Authorized Official - Last Name:POWELL
Authorized Official - Suffix:
Authorized Official - Credentials:RRT, RPSGT
Authorized Official - Phone:804-378-3713
Mailing Address - Street 1:430 SOUTHLAKE BLVD STE B11
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23236-3065
Mailing Address - Country:US
Mailing Address - Phone:804-378-3713
Mailing Address - Fax:804-594-2673
Practice Address - Street 1:430 SOUTHLAKE BLVD STE B11
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23236-3065
Practice Address - Country:US
Practice Address - Phone:804-378-6009
Practice Address - Fax:804-378-6187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-19
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
293D00000X
VA0206010011332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No293D00000XLaboratoriesPhysiological Laboratory