Provider Demographics
NPI:1538245857
Name:PREMIER DIAGNOSTIC IMAGING SOLUTIONS, INC.
Entity type:Organization
Organization Name:PREMIER DIAGNOSTIC IMAGING SOLUTIONS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:SALDANHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-987-3795
Mailing Address - Street 1:PO BOX 68726
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60168-0726
Mailing Address - Country:US
Mailing Address - Phone:847-699-7570
Mailing Address - Fax:847-296-5686
Practice Address - Street 1:9680 GOLF RD FL 2
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-1522
Practice Address - Country:US
Practice Address - Phone:847-699-7570
Practice Address - Fax:847-296-5686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-29
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01635120OtherBC/BS PROVIDER NUMBER
IL01635120OtherBC/BS PROVIDER NUMBER
IL=========001Medicaid
IL=========001Medicaid