Provider Demographics
NPI:1871838490
Name:PREMIER INTERVENTIONAL RADIOLOGY CLINIC
Entity Type:Organization
Organization Name:PREMIER INTERVENTIONAL RADIOLOGY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:VERNON
Authorized Official - Middle Name:W
Authorized Official - Last Name:BARROW
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:662-842-1758
Mailing Address - Street 1:620 CROSSOVER ROAD
Mailing Address - Street 2:
Mailing Address - City:TUPLEO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-4944
Mailing Address - Country:US
Mailing Address - Phone:662-842-1758
Mailing Address - Fax:662-844-8298
Practice Address - Street 1:891 MISSISSIPPI DR
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38804-0934
Practice Address - Country:US
Practice Address - Phone:662-620-7111
Practice Address - Fax:662-377-7954
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PREMIER RADIOLOGY, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-12-07
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Single Specialty