Provider Demographics
NPI:1285633370
Name:PREMIER IMAGING AND INTERVENTION, PLLC
Entity type:Organization
Organization Name:PREMIER IMAGING AND INTERVENTION, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-372-2731
Mailing Address - Street 1:PO BOX 11795
Mailing Address - Street 2:L-2543
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25339-1795
Mailing Address - Country:US
Mailing Address - Phone:866-871-7843
Mailing Address - Fax:614-764-9147
Practice Address - Street 1:122 PINNELL ST # 720
Practice Address - Street 2:
Practice Address - City:RIPLEY
Practice Address - State:WV
Practice Address - Zip Code:25271-9101
Practice Address - Country:US
Practice Address - Phone:866-871-7843
Practice Address - Fax:614-764-9147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-20
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYDA1551OtherRAILROAD MEDICARE
KY65939639Medicaid
WV001707565OtherBCBS
OH2694777Medicaid
WV3810007221Medicaid
KY000000289222OtherBCBS
WV001906613Medicaid
WV3810003604Medicaid
WV0207230000Medicaid
WV3810002570Medicaid
OH2649683Medicaid
WVDA1021OtherRAILROAD MEDICARE
KYDA1551OtherRAILROAD MEDICARE
WV9334241Medicare ID - Type Unspecified
WV3810002570Medicaid