Provider Demographics
NPI:1659377802
Name:PREMIER DIAGNOSTIC SERVICES, INC
Entity Type:Organization
Organization Name:PREMIER DIAGNOSTIC SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:MR
Authorized Official - First Name:BRYON
Authorized Official - Middle Name:L
Authorized Official - Last Name:BECKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-584-5600
Mailing Address - Street 1:378 PAGE ST.
Mailing Address - Street 2:SUITE 101
Mailing Address - City:STOUGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02072-1124
Mailing Address - Country:US
Mailing Address - Phone:800-346-2111
Mailing Address - Fax:508-584-6362
Practice Address - Street 1:378 PAGE ST.
Practice Address - Street 2:SUITE 101
Practice Address - City:STOUGHTON
Practice Address - State:MA
Practice Address - Zip Code:02072-1124
Practice Address - Country:US
Practice Address - Phone:800-346-2111
Practice Address - Fax:508-584-6362
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-22
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonographyGroup - Multi-Specialty
No246W00000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, CardiologyGroup - Multi-Specialty
No246XS1301XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularSonographyGroup - Multi-Specialty
No246ZE0500XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherEEGGroup - Multi-Specialty
No2471B0102XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistBone DensitometryGroup - Multi-Specialty
No2471V0105XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistVascular SonographyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1526260Medicaid
MA1850091Medicaid
NH76Y00737NH01OtherNH ANTHEM BC PROV
MA041169OtherBCMA IPDL#
MA327019OtherMA BC PROV
MA041169OtherBCMA IPDL#
MA1526260Medicaid
NH76Y00737NH01OtherNH ANTHEM BC PROV
RI479020445Medicare ID - Type UnspecifiedRI MCR PROV
MA470000076Medicare ID - Type UnspecifiedNATL RR MCR PROV