Provider Demographics
NPI:1104374891
Name:PREMIER LAB TESTING
Entity Type:Organization
Organization Name:PREMIER LAB TESTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CALVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BONDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-270-6647
Mailing Address - Street 1:9542 BROOKLINE AVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-1492
Mailing Address - Country:US
Mailing Address - Phone:225-573-8026
Mailing Address - Fax:
Practice Address - Street 1:9542 BROOKLINE AVE
Practice Address - Street 2:SUITE E
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-1492
Practice Address - Country:US
Practice Address - Phone:225-573-8026
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-12
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA69Medicaid