Provider Demographics
NPI:1487191573
Name:PREMIER LAB SOLUTIONS
Entity Type:Organization
Organization Name:PREMIER LAB SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JONI
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:OLTROGGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-441-2808
Mailing Address - Street 1:3440 N 16TH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-7125
Mailing Address - Country:US
Mailing Address - Phone:602-441-2808
Mailing Address - Fax:
Practice Address - Street 1:3440 N 16TH ST STE 200
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-7125
Practice Address - Country:US
Practice Address - Phone:602-441-2808
Practice Address - Fax:602-441-5481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-26
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory