Prime Labs LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

PRIME LABS LLC

Practice address

10619 S Jordan Gtwy Ste 125
South Jordan, UT 84095-4073

Phone

(385) 645-7400

Fax

(385) 645-7419

NPI assigned

Jan 20, 2021

Organization subpart

No

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

Authorized official

Name

Brandon Guy Taylor

Title

Owner

Phone

(385) 645-7400

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in UT

Enrollment records 1

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Mako Medical Laboratories, LLC

  • Clinical Medical Laboratory
  • Englewood, CO
  • NPI 1932981529

  Member Of

  NPD member

Locations

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

{
    "created_epoch": "1611100800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1711497600000",
    "number": "1639769953",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10619 S JORDAN GTWY STE 125",
            "city": "SOUTH JORDAN",
            "state": "UT",
            "postal_code": "840954073",
            "telephone_number": "385-645-7400",
            "fax_number": "385-645-7419"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10619 S JORDAN GTWY STE 125",
            "city": "SOUTH JORDAN",
            "state": "UT",
            "postal_code": "840954073",
            "telephone_number": "385-645-7400",
            "fax_number": "385-645-7419"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11762 S State St Ste 355",
            "address_purpose": "LOCATION",
            "city": "Draper",
            "state": "UT",
            "postal_code": "840207166",
            "country_code": "US",
            "telephone_number": "801-361-4381",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PRIME LABS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-01-20",
        "last_updated": "2024-03-27",
        "certification_date": "2024-03-27",
        "status": "A",
        "authorized_official_last_name": "TAYLOR",
        "authorized_official_first_name": "BRANDON",
        "authorized_official_middle_name": "GUY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "385-645-7400"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Clayton Daniel Powers, DPT
• Premier Medical Distribution
• Joshua Presley, DDS
• Christopher Joseph Price, DDS, MD
• Primary Function, PLLC
• Terra Prince, ACMHC
• Pro Smiles Utah LLC
• Tyler Proctor, DC
• Progressive Eye Care, LLC
• Promise Hospital

• Clinical Medical Laboratory in South Jordan, UT
• Providers in South Jordan, UT by specialty
• Clinical Medical Laboratory in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2024; 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.