Provider Demographics
NPI:1316949886
Name:PREMIER HEALTH SERVICES, INC
Entity type:Organization
Organization Name:PREMIER HEALTH SERVICES, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:REGIONAL DIRECTOR OF NETWORK DEVELO
Authorized Official - Prefix:
Authorized Official - First Name:CLERISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:HADLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-215-7410
Mailing Address - Street 1:PO BOX 674242
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75267-4242
Mailing Address - Country:US
Mailing Address - Phone:312-335-1155
Mailing Address - Fax:312-335-9098
Practice Address - Street 1:559 WEST KINZIE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60654
Practice Address - Country:US
Practice Address - Phone:312-335-1155
Practice Address - Fax:312-335-9098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-13
Last Update Date:2018-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
574840OtherMEDICARE PTAN
IL=========-003Medicaid