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General NPI Number Information
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NPI Number | 1104226224
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Entity Type | Organization
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Legal Business Name | PREMIER DRAW SERVICES LLC
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Dates
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Enumeration Date | 08/26/2014
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Last Update Date | 08/26/2014
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Provider Practice Location Address
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Address Line | 508 E MINERAL RD
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City | PHOENIX
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State | AZ
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Zip | 85042-8327
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Country | US
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Telephone | 602-318-5854
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Fax | 602-274-0771
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Provider Business Mailing Address
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Address Line | 508 E MINERAL RD
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City | PHOENIX
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State | AZ
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Zip | 85042-8327
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Country | US
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Telephone | 602-318-5854
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Fax | 602-274-0771
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Authorized Official
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Title or Position | PHLEBOTOMIST
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Name | OSMIN A DURAN
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Credential | PST
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Telephone | 602-318-5854
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State | AZ
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