Organization
PREMIER MEDICAL IMAGING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GARDNER BARTROM (PRESIDENT)
(765) 228-4660
Entity
Organization
Contact information
Practice address
2855 MILLER DR STE 113B, PLYMOUTH, IN 46563-8091
(574) 941-1090
(574) 941-1095
Mailing address
PO BOX 338, LA FONTAINE, IN 46940-0338
(765) 228-4660
(765) 847-4343
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
261QM1300X
Multi-Specialty Clinic/Center
—
—
261QR0200X
Radiology Clinic/Center
—
—
Other
Enumeration date
03/29/2022
Last updated
01/08/2024
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