Provider Demographics
NPI:1407030141
Name:PREMIER MEDICAL ASSOCIATES, PC
Entity Type:Organization
Organization Name:PREMIER MEDICAL ASSOCIATES, PC
Other - Org Name:PREMIER MEDICAL RADIOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:DERUBEIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-457-0060
Mailing Address - Street 1:3824 NORTHERN PIKE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146-2141
Mailing Address - Country:US
Mailing Address - Phone:412-457-0060
Mailing Address - Fax:412-457-0092
Practice Address - Street 1:3824 NORTHERN PIKE
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-2141
Practice Address - Country:US
Practice Address - Phone:412-457-0175
Practice Address - Fax:412-547-0179
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PREMIER MEDICAL ASSOCIATES, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-18
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA008511Medicare PIN