NPIMap

Organization Active NPI

Premiertox 2.0 Inc

Doing business as Premiertox Laboratory

  • Clinical Medical Laboratory
  • Danville, KY
National Provider Identifier
1205124674
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
License
200322 Issued in KY
Legal business name
PREMIERTOX 2.0 INC
Doing business as
Premiertox Laboratory
Practice address
128 Daniel Dr
Danville, KY 40422-2527
Phone
(877) 412-8330
Fax
(844) 982-0300
NPI assigned
Jul 19, 2011
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
PREMIERTOX 2.0 INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Steven E Klipp
Title
President
Phone
(877) 412-8330

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X
Clinical Medical Laboratory 291U00000X 200322 KY Primary

Addresses

Primary practice location

128 Daniel Dr
Danville, KY 40422-2527

Mailing address

PO Box 638995
Cincinnati, OH 45263-8995
Phone (877) 412-8330

Other names 1

  • Premiertox Laboratory Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120319000741 KY Part B Supplier - Independent Clinical Laboratory 8224202403 5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Jamestown, KY; Middlesboro, KY

Other NPIs on the same Medicare enrollment 5

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Part of
Premiertox Lab Albany

Locations

128 Daniel Dr
Danville, KY 40422
Phone (606) 875-3196

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1311033600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1205124674",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 638995",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452638995",
            "telephone_number": "877-412-8330",
            "fax_number": "844-982-0300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "128 DANIEL DR",
            "city": "DANVILLE",
            "state": "KY",
            "postal_code": "404222527",
            "telephone_number": "877-412-8330",
            "fax_number": "844-982-0300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIERTOX 2.0 INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PREMIERTOX 2.0 INC",
        "enumeration_date": "2011-07-19",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "KLIPP",
        "authorized_official_first_name": "STEVEN",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "877-412-8330"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "KY",
            "license": "200322",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Premiertox Laboratory",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Danville, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.