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Premier Radiology, Inc

Organization Active NPI Diagnostic Radiology Physician · Tupelo, MS

NPI 1083669121 · NPPES record last updated Jun 23, 2020

Key facts

NPI
1083669121
Entity type
Organization (NPI type 2)
Primary specialty
Diagnostic Radiology Physician 2085R0202X
Legal business name
PREMIER RADIOLOGY, INC
Practice address
620 Crossover Road
Tupelo, MS 38801
Phone
(662) 620-7101
NPI assigned
May 24, 2006
Organization subpart
No

Authorized official

Name
Jeffrey Carlton Howard, MD NPI 1821037177
Title
President
Phone
(662) 620-7102

Authorized official NPPES reports the authorized official by name only; the link goes to the one practitioner connected to this organization with that name.

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Corporate family (same tax ID) 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners 62

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 62

Medicare participation

Medicare fee-for-service enrollment
Enrolled (6 enrollments) in MS, AL, TN, TX, OH, NY

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20040730000681 MS Part B Supplier - Clinic/Group Practice 2769452242 Receives reassigned benefits from 29 practitioners
Practice locations: Tupelo, MS; Belden, MS; Columbus, MS; Amory, MS; Corinth, MS; Nettleton, MS; Starkville, MS; Saltillo, MS…
O20060123000851 AL Part B Supplier - Clinic/Group Practice 2769452242 Receives reassigned benefits from 20 practitioners
Practice locations: Hamilton, AL; Mobile, AL
O20240216003672 TN Part B Supplier - Clinic/Group Practice 2769452242 Receives reassigned benefits from 3 practitioners
Practice locations: Clarksville, TN; Germantown, TN; Greeneville, TN
O20240426002013 TX Part B Supplier - Clinic/Group Practice 2769452242 Receives reassigned benefits from 1 practitioner
Practice locations: Terrell Hills, TX
O20240730002484 OH Part B Supplier - Clinic/Group Practice 2769452242 Receives reassigned benefits from 1 practitioner
Practice locations: Beavercreek, OH
O20260506001681 NY Part B Supplier - Clinic/Group Practice 2769452242 Receives reassigned benefits from 1 practitioner
Practice locations: Buffalo, NY

National Provider Directory

Tax ID family
Radiology of North Ms W (2 organizations share this tax ID)

Locations

56 Dutch Ln
Columbus, MS 39702
Phone (662) 329-3808

4508 Hwy 45 S
Columbus, MS 39701

3302 W Linden St
#A
Corinth, MS 38834
Phone (662) 331-1956

1202 Office Park Dr
Oxford, MS 38655
Phone (662) 513-0055

499 Gloster Creek Vlg
Ste A2T
Tupelo, MS 38801

1040A S Madison St
Tupelo, MS 38801
Phone (662) 842-2170

320 S Gloster St
Tupelo, MS 38801
Phone (662) 821-1831

4250 S Eason Blvd
Tupelo, MS 38801
Phone (662) 377-5265

499 Gloster Creek Vlg
Ste A1
Tupelo, MS 38801
Phone (662) 377-7100

600 W Eason Blvd
Tupelo, MS 38801

913 Garfield St
Tupelo, MS 38801

111 Troy St
Ste F
Tupelo, MS 38804

620 Crossover Rd
Tupelo, MS 38801
Phone (662) 620-7101

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician
Group: 193400000X MULTIPLE SINGLE SPECIALTY GROUP		 2085R0202X Yes

Addresses

Primary practice location

620 Crossover Road
Tupelo, MS 38801

Mailing address

620 Crossover Rd
Tupelo, MS 38801-4944
Phone (662) 842-1758

Other identifiers

IdentifierTypeStateIssuer
2954OtherALMEDICARE
CE6077OtherMSRAILROAD MEDICARE
9011191MedicaidMS
529700060MedicaidAL

Other providers in Tupelo, MS

All providers in Tupelo, MS · Diagnostic Radiology Physician in Mississippi

Sources for this page

Verify at the official NPI Registry.