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General NPI Number Information
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NPI Number | 1891181038
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Entity Type | Organization
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Legal Business Name | PREMIER LABS, LLC
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Dates
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Enumeration Date | 04/14/2015
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Last Update Date | 11/28/2016
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Provider Practice Location Address
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Address Line | 1111 W 17TH ST ATTN: JARRAD WAGNER
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City | TULSA
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State | OK
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Zip | 74107-1886
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Country | US
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Telephone | 541-301-8476
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Fax | 541-708-0949
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Provider Business Mailing Address
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Address Line | 302 E HERSEY ST SUITE # 8
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City | ASHLAND
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State | OR
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Zip | 97520-1200
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Country | US
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Telephone | 541-301-8476
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Fax | 541-708-0949
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Authorized Official
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Title or Position | OWNER
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Name | JESSE L SEERY
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Credential |
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Telephone | 541-301-8476
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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 |
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