Provider Demographics
NPI:1629028204
Name:PREMIER IMAGING MANAGEMENT COMPANY
Entity Type:Organization
Organization Name:PREMIER IMAGING MANAGEMENT COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ORLOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-766-7736
Mailing Address - Street 1:PO BOX 93696
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90093-0696
Mailing Address - Country:US
Mailing Address - Phone:818-766-7736
Mailing Address - Fax:
Practice Address - Street 1:11490 BURBANK BLVD
Practice Address - Street 2:SUITE 3F
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91601-2389
Practice Address - Country:US
Practice Address - Phone:818-766-7736
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TG130Medicare ID - Type Unspecified