Provider Demographics
NPI:1205124674
Name:PREMIERTOX 2.0 INC
Entity type:Organization
Organization Name:PREMIERTOX 2.0 INC
Other - Org Name:<UNAVAIL>
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:877-412-8330
Mailing Address - Street 1:PO BOX 638995
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-8995
Mailing Address - Country:US
Mailing Address - Phone:877-412-8330
Mailing Address - Fax:844-982-0300
Practice Address - Street 1:128 DANIEL DR
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:KY
Practice Address - Zip Code:40422-2527
Practice Address - Country:US
Practice Address - Phone:877-412-8330
Practice Address - Fax:844-982-0300
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PREMIERTOX 2.0 INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-07-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
291U00000X
KY200322291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory