MEDICARE: PREMIER PATHOLOGY LABORATORIES INC

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1801858964
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIER PATHOLOGY LABORATORIES INC

Provider Business Mailing Address
First Line	:	PO BOX 10076
Second Line	:
City	:	VAN NUYS
State	:	CA
Zip	:	91410-0076
Country	:	US
Telephone Number	:	805-578-8300
Fax Number	:	805-578-8950

Provider Business Practice Location Address
First Line	:	263 PEARSON DR
Second Line	:	SUITE 108
City	:	PORTERVILLE
State	:	CA
Zip	:	93257-3333
Country	:	US
Telephone Number	:	559-721-5174
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DEBRA HANKS
Credential	:	MD
Telephone Number	:	559-781-5174

Provider Enumeration Date	:	04/04/2006
Last Update Date	:	07/29/2008

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