MEDICARE: PREMIER LAB TESTING LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1225784788
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIER LAB TESTING LLC

Provider Business Mailing Address
First Line	:	6204 S COOPER ST STE 104
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76001-5709
Country	:	US
Telephone Number	:	972-841-2305
Fax Number	:

Provider Business Practice Location Address
First Line	:	2912 W NORTHWEST HWY
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75220-6218
Country	:	US
Telephone Number	:	972-841-2305
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	FATIMA KAMARA
Credential	:	DDS
Telephone Number	:	972-841-2305

Provider Enumeration Date	:	02/23/2022
Last Update Date	:	02/23/2022

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Directions to “PREMIER LAB TESTING LLC ” Practice Location

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