Organization
PREMIER DIAGNOSTIC IMAGING, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAYAPRAKASARAO KONIJETI MD (OWNER)
(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
291U00000X
Clinical Medical Laboratory
Primary
15D1048961
IN
Other
Enumeration date
12/18/2008
Last updated
12/18/2008
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