Provider Demographics
NPI:1023111804
Name:PREMIER MRI SERVICES LLC
Entity type:Organization
Organization Name:PREMIER MRI SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:
Authorized Official - Last Name:DUBIANSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-267-1780
Mailing Address - Street 1:107 RIDGLEY AVE
Mailing Address - Street 2:SUITE 12
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401
Mailing Address - Country:US
Mailing Address - Phone:410-267-1780
Mailing Address - Fax:410-267-1784
Practice Address - Street 1:107 RIDGLEY AVE
Practice Address - Street 2:SUITE 12
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401
Practice Address - Country:US
Practice Address - Phone:410-267-1780
Practice Address - Fax:410-267-1784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDM231261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD9398PROtherBLUE SHIELD OF MARYLAND
DCK646OtherBLUE SHIELD DC
DCK646OtherBLUE SHIELD DC