Provider Demographics
NPI:1548413131
Name:PREMIER DIAGONSTIC IMAGING, INC
Entity Type:Organization
Organization Name:PREMIER DIAGONSTIC IMAGING, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:ALGOO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-746-8001
Mailing Address - Street 1:12800 HIGHWAY 55
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55441-3840
Mailing Address - Country:US
Mailing Address - Phone:763-746-8001
Mailing Address - Fax:763-746-8004
Practice Address - Street 1:12800 HIGHWAY 55
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55441-3840
Practice Address - Country:US
Practice Address - Phone:763-746-8001
Practice Address - Fax:763-746-8004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty