Organization
PREMIER MOBILE LAB LLC
Active
Other names
Premier Mobile Lab LLC
Organization subpart
No
Provider details
NPI number
Authorized official
RANDALL DEAN WILCOX PHLEBOTOMY (CEO)
(575) 520-3254
Entity
Organization
Contact information
Practice address
383 FOSSIL VIEW RD, LAS CRUCES, NM 88007-7176
(575) 520-3254
Mailing address
PO BOX 155, RADIUM SPRINGS, NM 88054-0155
(575) 520-3254
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
—
—
291U00000X
Clinical Medical Laboratory
Primary
—
—
305S00000X
Point of Service
—
—
310500000X
Mental Illness Intermediate Care Facility
—
—
332800000X
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
246RP1900X
—
NM
Enumeration date
01/25/2019
Last updated
01/25/2019
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us