Provider Demographics
NPI:1417475872
Name:PREMIER MEDICAL ASSOCIATES OF FLORIDA LLC
Entity Type:Organization
Organization Name:PREMIER MEDICAL ASSOCIATES OF FLORIDA LLC
Other - Org Name:PIONEER CLINICAL LABS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LAB MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:R
Authorized Official - Last Name:KOP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-362-0627
Mailing Address - Street 1:9311 SW HIGHWAY 200 # A2
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34481-9657
Mailing Address - Country:US
Mailing Address - Phone:352-362-0627
Mailing Address - Fax:877-573-9013
Practice Address - Street 1:9311 SW HIGHWAY 200 # A2
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34481-9657
Practice Address - Country:US
Practice Address - Phone:352-362-0627
Practice Address - Fax:877-573-9013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-06
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247ZC0005XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyClinical Laboratory Director, Non-physicianGroup - Single Specialty
No246RM2200XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyMedical LaboratoryGroup - Single Specialty