| NPI | 1740744614 |
|---|---|
| Former Legal Business Name | PREMIER MOBILE LAB LLC |
| Entity Type | Organization |
| Authorized Contact | RANDALL DEAN WILCOX CEO 575-520-3254 |
| Organization Subpart ? | No |
| Primary Taxonomy | 291U00000X Clinical Medical Laboratory |
| Additional Taxonomies | 251E00000X Home Health |
| 305S00000X Point of Service | |
| 310500000X Intermediate Care Facility, Mental Illness | |
| 332800000X Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | |
| Enumeration Date | 2019-01-25 |
| Last Update Date | 2019-01-25 |