Provider Demographics
NPI:1306939962
Name:PREMIER RADIOLOGY GROUP, INC.
Entity type:Organization
Organization Name:PREMIER RADIOLOGY GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:E
Authorized Official - Last Name:OSBORN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:937-398-0500
Mailing Address - Street 1:2145 N. FAIRFIELD RD.
Mailing Address - Street 2:SUITE A
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45431
Mailing Address - Country:US
Mailing Address - Phone:937-431-9729
Mailing Address - Fax:937-431-9731
Practice Address - Street 1:2145 N. FAIRFIELD RD.
Practice Address - Street 2:SUITE A
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45431
Practice Address - Country:US
Practice Address - Phone:937-431-9729
Practice Address - Fax:937-431-9731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0610IC2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH16-01294OtherUHC GROUP NUMBER
OHIC133OtherHUMANA GROUP NUMBER
OH2133882Medicaid
OH6393474001OtherCIGNA GROUP NUMBER
OH4500901OtherAETNA GROUP NUMBER
OH206519OtherANTHEM GROUP NUMBER
OHIC133OtherHUMANA GROUP NUMBER