Organization
PREMIER DIAGNOSTIC IMAGING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAYAPRAKASARAO KONIJETI M.D. (MEDICAL DIRECTOR)
(812) 478-3900
Entity
Organization
Contact information
Practice address
135 E MCCALLISTER DR, TERRE HAUTE, IN 47802-4247
(812) 478-3900
(812) 478-5868
Mailing address
135 E MCCALLISTER DR, TERRE HAUTE, IN 47802-4247
(812) 478-3900
(812) 478-5868
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
XF201098
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200514950
—
IN
Enumeration date
07/06/2006
Last updated
11/02/2007
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