Provider Demographics
NPI:1932500121
Name:PREMIERTOX 2.0 INC
Entity Type:Organization
Organization Name:PREMIERTOX 2.0 INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:E
Authorized Official - Last Name:KLIPP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-866-8854
Mailing Address - Street 1:PO BOX 538512
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30353-8512
Mailing Address - Country:US
Mailing Address - Phone:502-226-3858
Mailing Address - Fax:502-223-9829
Practice Address - Street 1:43 WACO DR
Practice Address - Street 2:#7
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-8327
Practice Address - Country:US
Practice Address - Phone:270-866-5027
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-08
Last Update Date:2015-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory