Healthcare Provider Details

I. General information

NPI: 1023935970
Provider Name (Legal Business Name): PREMIER CLINICAL LABORATORY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 10/03/2026
Certification Date: 10/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3499 BLAZER PKWY STE 330
LEXINGTON KY
40509-2828
US

IV. Provider business mailing address

3499 BLAZER PKWY STE 330
LEXINGTON KY
40509-2828
US

V. Phone/Fax

Practice location:
  • Phone: 346-396-1252
  • Fax:
Mailing address:
  • Phone: 346-396-1252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number StateNULL

VIII. Authorized Official

Name: TANZEEM AHMED
Title or Position: OWNER
Credential:
Phone: 346-396-1252