Provider Demographics
NPI:1477143204
Name:PRIMARYLAB LLC
Entity Type:Organization
Organization Name:PRIMARYLAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/EXECUTIVE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LAKESHA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAIRSTON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:210-706-0512
Mailing Address - Street 1:PO BOX 690443
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78269-0443
Mailing Address - Country:US
Mailing Address - Phone:210-706-0512
Mailing Address - Fax:
Practice Address - Street 1:700 S ZARZAMORA ST STE 300
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78207-5249
Practice Address - Country:US
Practice Address - Phone:210-706-0512
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-26
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
No251J00000XAgenciesNursing Care