Provider Demographics
NPI:1144718792
Name:PREMIER HEALTH EXPRESS AND ADVANCED DIAGNOSTICS INC
Entity type:Organization
Organization Name:PREMIER HEALTH EXPRESS AND ADVANCED DIAGNOSTICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATIONS OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-836-5376
Mailing Address - Street 1:9710 PATUXENT WOODS DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21046-1526
Mailing Address - Country:US
Mailing Address - Phone:443-899-9525
Mailing Address - Fax:443-200-0233
Practice Address - Street 1:9710 PATUXENT WOODS DR STE 200
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-3458
Practice Address - Country:US
Practice Address - Phone:443-452-0739
Practice Address - Fax:443-200-0233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-30
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207R00000X
MDD0070766261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty