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Organization
PREMIER DIAGNOSTICS LLC
Active
Organization
PREMIER DIAGNOSTICS LLC
Active
Other names
Centennial Neurodiagnostics LLC
Organization subpart
No
Provider details
NPI number
Authorized official
KENNETH WEATHERWAX (DIRECTOR)
(469) 646-8663
Entity
Organization
Contact information
Practice address
3838 OAK LAWN AVE STE 1420, DALLAS, TX 75219-4515
(888) 482-2334
Mailing address
3838 OAK LAWN AVE STE 1420, DALLAS, TX 75219-4515
(888) 482-2334
Taxonomy
Speciality
Code
Description
License number
State
204R00000X
Electrodiagnostic Medicine Physician
—
—
246ZE0500X
EEG Specialist/Technologist
—
—
293D00000X
Physiological Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104480100
—
FL
05
—
3875247
—
TX
Enumeration date
06/20/2017
Last updated
09/02/2025
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