| Premier Medical Imaging Llc | |
|
2855 Miller Dr Ste 113b Plymouth IN 46563-8091 | |
| (574) 941-1090 | |
| (574) 941-1095 |
| Full Name | Premier Medical Imaging Llc |
|---|---|
| Speciality | Radiology |
| Location | 2855 Miller Dr Ste 113b, Plymouth, Indiana |
| Authorized Official Name and Position | Gardner Bartrom (PRESIDENT) |
| Authorized Official Contact | 7652284660 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Premier Medical Imaging Llc Po Box 338 La Fontaine IN 46940-0338 Ph: (765) 228-4660 | Premier Medical Imaging Llc 2855 Miller Dr Ste 113b Plymouth IN 46563-8091 Ph: (574) 941-1090 |
| NPI Number | 1386384360 |
|---|---|
| Provider Enumeration Date | 03/29/2022 |
| Last Update Date | 01/08/2024 |
| Medicare PECOS PAC ID | 7113264714 |
|---|---|
| Medicare Enrollment ID | O20220428001945 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386384360 | NPI | - | NPPES |
| Provider Name | V Durga Madhusudana Rao |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1487682167 PECOS PAC ID: 8628062098 Enrollment ID: I20040409000557 |
| Provider Name | Orlando A Landrum |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1932159910 PECOS PAC ID: 0042229387 Enrollment ID: I20110606000129 |
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