Provider Demographics
NPI:1700286135
Name:PREMIER PATHOLOGY LAB, LLC
Entity Type:Organization
Organization Name:PREMIER PATHOLOGY LAB, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THINH
Authorized Official - Middle Name:
Authorized Official - Last Name:PHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:888-416-8118
Mailing Address - Street 1:19073 NORTH I-45 FWY STE 145
Mailing Address - Street 2:
Mailing Address - City:SHENANDOAH
Mailing Address - State:TX
Mailing Address - Zip Code:77385-8744
Mailing Address - Country:US
Mailing Address - Phone:936-231-8027
Mailing Address - Fax:281-476-7798
Practice Address - Street 1:230 ED ENGLISH DR UNIT D
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77385-8744
Practice Address - Country:US
Practice Address - Phone:936-231-8027
Practice Address - Fax:281-476-7798
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-04
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory