Provider Demographics
NPI:1174635361
Name:PREMIER DIAGNOSTICS INC
Entity type:Organization
Organization Name:PREMIER DIAGNOSTICS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:CURTIS
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:RCP RRT
Authorized Official - Phone:805-485-2633
Mailing Address - Street 1:1851 HOLSER WALK
Mailing Address - Street 2:SUITE 210
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93036-2626
Mailing Address - Country:US
Mailing Address - Phone:805-485-2633
Mailing Address - Fax:805-485-6650
Practice Address - Street 1:1851 HOLSER WALK
Practice Address - Street 2:SUITE 210
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036-2626
Practice Address - Country:US
Practice Address - Phone:805-485-2633
Practice Address - Fax:805-485-6650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
TG204Medicare ID - Type Unspecified