Provider Demographics
NPI:1790220481
Name:PREMIER DIAGNOSTIC CENTER
Entity Type:Organization
Organization Name:PREMIER DIAGNOSTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ZACHERY
Authorized Official - Middle Name:
Authorized Official - Last Name:WEST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-506-2181
Mailing Address - Street 1:10311 HOMESTEAD ROAD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77016
Mailing Address - Country:US
Mailing Address - Phone:832-506-2181
Mailing Address - Fax:180-091-8697
Practice Address - Street 1:10311 HOMESTEAD ROAD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77016
Practice Address - Country:US
Practice Address - Phone:832-506-2181
Practice Address - Fax:180-091-8697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-04
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service