Provider Demographics
NPI:1528403482
Name:PREMIER DIAGNOSTIC TESTING, INC.
Entity Type:Organization
Organization Name:PREMIER DIAGNOSTIC TESTING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:
Authorized Official - Last Name:KANTOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-868-6380
Mailing Address - Street 1:12515 ORANGE DR
Mailing Address - Street 2:SUITE 808
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33330-4309
Mailing Address - Country:US
Mailing Address - Phone:954-868-6380
Mailing Address - Fax:
Practice Address - Street 1:12515 ORANGE DR
Practice Address - Street 2:SUITE 808
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33330-4309
Practice Address - Country:US
Practice Address - Phone:954-868-6380
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-06
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty