Provider Demographics
NPI:1437369022
Name:PRIOR RADIOLOGY SERVICES PA
Entity Type:Organization
Organization Name:PRIOR RADIOLOGY SERVICES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:S
Authorized Official - Last Name:PRIOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:662-334-9829
Mailing Address - Street 1:136 FIORANELLI DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38701-7313
Mailing Address - Country:US
Mailing Address - Phone:662-334-9829
Mailing Address - Fax:662-334-3529
Practice Address - Street 1:1400 E UNION ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MS
Practice Address - Zip Code:38703-3246
Practice Address - Country:US
Practice Address - Phone:662-334-9829
Practice Address - Fax:662-334-3529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS147562085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS01100733Medicaid
MS184441304HOtherBLUE CROSS MS
MSDA8940OtherRAILROAD MEDICARE
MSDA8940OtherRAILROAD MEDICARE