Provider Demographics
NPI:1992183024
Name:PREMIER WOMEN'S HEALTH
Entity Type:Organization
Organization Name:PREMIER WOMEN'S HEALTH
Other - Org Name:DIAGNOSTIC IMAGING OF SEWICKLEY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER-PROVIDER ENROLLMENT
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:NOEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-330-5112
Mailing Address - Street 1:301 OHIO RIVER BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:SEWICKLEY
Mailing Address - State:PA
Mailing Address - Zip Code:15143-1300
Mailing Address - Country:US
Mailing Address - Phone:412-741-6530
Mailing Address - Fax:412-741-9274
Practice Address - Street 1:301 OHIO RIVER BLVD STE 300
Practice Address - Street 2:
Practice Address - City:SEWICKLEY
Practice Address - State:PA
Practice Address - Zip Code:15143-1300
Practice Address - Country:US
Practice Address - Phone:412-741-6530
Practice Address - Fax:412-741-9274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-08
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1029462430002Medicaid
479596Medicare PIN