Provider Demographics
NPI:1659351963
Name:PREMIER IMAGING GROUP, INC
Entity Type:Organization
Organization Name:PREMIER IMAGING GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:E
Authorized Official - Last Name:OSBORN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:937-398-0503
Mailing Address - Street 1:PO BOX 1524
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45802-1524
Mailing Address - Country:US
Mailing Address - Phone:419-224-5707
Mailing Address - Fax:419-229-0040
Practice Address - Street 1:715 S TAFT AVE
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:OH
Practice Address - Zip Code:43420-3200
Practice Address - Country:US
Practice Address - Phone:419-332-7321
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000178618OtherANTHEM
OH2201585Medicaid
OHPR9312241Medicare ID - Type Unspecified