Provider Demographics
NPI:1063142750
Name:PREMIER DIAGNOSTIC IMAGING INC
Entity type:Organization
Organization Name:PREMIER DIAGNOSTIC IMAGING INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NATAUSHA
Authorized Official - Middle Name:
Authorized Official - Last Name:GLIDWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:432-438-1322
Mailing Address - Street 1:850 TOWER DR STE 111
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79761-4252
Mailing Address - Country:US
Mailing Address - Phone:432-438-1322
Mailing Address - Fax:
Practice Address - Street 1:850 TOWER DR STE 111
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-4252
Practice Address - Country:US
Practice Address - Phone:432-888-4886
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-15
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Single Specialty
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty