PREMIER INTERVENTIONAL AND DIAGNOSTIC RADIOLOGY CORP NPI 1801437041

NPI Information

  • NPI: 1801437041
  • Provider Name: PREMIER INTERVENTIONAL AND DIAGNOSTIC RADIOLOGY CORP
  • Classification: Radiology - 2085R0204X
  • Specialization: Vascular & Interventional Radiology
  • Entity Type: Organization
  • Doing Business As: PREMIER VASCULAR AND INTERVENTIONAL
  • CLIA Number: 10D2271625
  • Address: 7556 LAKE WORTH RD STE 103
    LAKE WORTH, FL
    ZIP 33467
  • Phone: (561) 894-1370

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NPI Details

PREMIER INTERVENTIONAL AND DIAGNOSTIC RADIOLOGY CORP is a vascular and interventional radiology radiology in Lake Worth, FL. The provider is a radiologist who diagnoses and treats diseases by various radiologic imaging modalities. These include fluoroscopy, digital radiography, computed tomography, sonography and magnetic resonance imaging. PREMIER INTERVENTIONAL AND DIAGNOSTIC RADIOLOGY CORP NPI is 1801437041. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Premier Vascular And Interventional.

The provider's business location address is:

7556 LAKE WORTH RD STE 103
LAKE WORTH, FL
ZIP 33467-503
Phone: (561) 894-1370
Fax: (561) 894-1372

The provider's authorized official is Emilio Lopez .
The authorized official title is Authorized Official/owner and has the following contact phone number (786) 547-7655.

The CLIA number assigned to this NPI record is 10D2271625 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 9/30/2019 and was last updated on 4/10/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
12085R0204XRadiologyVascular & Interventional RadiologyYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1104439200MEDICAIDFLORIDA

What is NPI?

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This page was last updated on: 11/21/2025

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