Provider Demographics
NPI:1619574621
Name:PRESTIGE LABORATORY SERVICES LLC
Entity Type:Organization
Organization Name:PRESTIGE LABORATORY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:NORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-341-7295
Mailing Address - Street 1:857 DOWNTOWNER BLVD STE H
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36609-5420
Mailing Address - Country:US
Mailing Address - Phone:251-341-7295
Mailing Address - Fax:251-341-7690
Practice Address - Street 1:857 DOWNTOWNER BLVD STE H
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36609-5420
Practice Address - Country:US
Practice Address - Phone:251-341-7295
Practice Address - Fax:251-341-7690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-02
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory