Provider Demographics
NPI:1023556016
Name:PRIME LABORATORY, LLC
Entity Type:Organization
Organization Name:PRIME LABORATORY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MAHNAZ
Authorized Official - Middle Name:
Authorized Official - Last Name:JAFFRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:855-996-2666
Mailing Address - Street 1:28266 FRANKLIN RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-1659
Mailing Address - Country:US
Mailing Address - Phone:855-996-2666
Mailing Address - Fax:888-679-1304
Practice Address - Street 1:28266 FRANKLIN RD
Practice Address - Street 2:SUITE A
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1659
Practice Address - Country:US
Practice Address - Phone:855-996-2666
Practice Address - Fax:888-679-1304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-09
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory