Provider Demographics
NPI:1497873525
Name:PREMIER RADIOLOGY SERVICES PSC
Entity Type:Organization
Organization Name:PREMIER RADIOLOGY SERVICES PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:BURNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:800-824-2544
Mailing Address - Street 1:PO BOX 8035
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44711-8035
Mailing Address - Country:US
Mailing Address - Phone:800-824-2544
Mailing Address - Fax:
Practice Address - Street 1:1801 ASHLEY CIR
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-3362
Practice Address - Country:US
Practice Address - Phone:800-824-2544
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64060155Medicaid
KY7502Medicare PIN