Provider Demographics
NPI:1457164576
Name:PRESTIGE LAB SERVICES LLC
Entity type:Organization
Organization Name:PRESTIGE LAB SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:TAMEIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:TATE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-302-2235
Mailing Address - Street 1:200 STROUPE RD STE C
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28056-8693
Mailing Address - Country:US
Mailing Address - Phone:888-302-2235
Mailing Address - Fax:980-225-5270
Practice Address - Street 1:1556 UNION RD STE D
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-2208
Practice Address - Country:US
Practice Address - Phone:888-302-2235
Practice Address - Fax:980-225-5270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-31
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center