Provider Demographics
NPI:1376601104
Name:PREMIER IMAGING CENTER, LLC
Entity Type:Organization
Organization Name:PREMIER IMAGING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SELINDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:HARP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-442-1616
Mailing Address - Street 1:46 SEARGENT S. PRENTISS DRIVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NATCHEZ
Mailing Address - State:MS
Mailing Address - Zip Code:39120
Mailing Address - Country:US
Mailing Address - Phone:601-442-1616
Mailing Address - Fax:601-442-5778
Practice Address - Street 1:46 SEARGENT S. PRENTISS DRIVE
Practice Address - Street 2:SUITE 100
Practice Address - City:NATCHEZ
Practice Address - State:MS
Practice Address - Zip Code:39120
Practice Address - Country:US
Practice Address - Phone:601-442-1616
Practice Address - Fax:601-442-5778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS7030261QR0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mammography