Organization
PREMIER MEDICAL IMAGING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACKIE-DEE GARDNER BARTROM (PRESIDENT)
(765) 228-4660
Entity
Organization
Contact information
Practice address
2855 MILLER DR STE 113, PLYMOUTH, IN 46563-8091
(765) 228-4660
Mailing address
PO BOX 338, LA FONTAINE, IN 46940-0338
(765) 228-4660
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300021965
—
IN
Enumeration date
09/11/2018
Last updated
04/17/2020
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