Provider Demographics
NPI:1710631049
Name:PREMIER 1 LABS , LLC
Entity Type:Organization
Organization Name:PREMIER 1 LABS , LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:CHANTAL
Authorized Official - Middle Name:L
Authorized Official - Last Name:SWART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:682-477-4014
Mailing Address - Street 1:535 S NOLEN DR STE 100
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-9194
Mailing Address - Country:US
Mailing Address - Phone:682-477-4014
Mailing Address - Fax:682-477-4038
Practice Address - Street 1:535 S NOLEN DR STE 100
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-9194
Practice Address - Country:US
Practice Address - Phone:682-477-4014
Practice Address - Fax:682-477-4038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-06
Last Update Date:2022-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX45D2251727OtherCLIA