NPIMap

Organization Active NPI

Premiertox 2.0 Inc.

  • Clinical Medical Laboratory
  • Campbellsville, KY
National Provider Identifier
1649671827
Registry record updated May 8, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
Legal business name
PREMIERTOX 2.0 INC.
Practice address
150 W Bear Track Rd
Campbellsville, KY 42718-8709
Phone
(270) 858-3343
NPI assigned
Sep 8, 2014
Last updated
May 8, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 8, 2015

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
(270) 866-8854

Specialties & licenses 1

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

Addresses

Primary practice location

150 W Bear Track Rd
Campbellsville, KY 42718-8709

Mailing address

PO Box 538512
Atlanta, GA 30353-8512
Phone (502) 226-3858

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

NPI Registry JSON

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

{
    "created_epoch": "1410134400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1431043200000",
    "number": "1649671827",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 538512",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303538512",
            "telephone_number": "502-226-3858"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 W BEAR TRACK RD",
            "city": "CAMPBELLSVILLE",
            "state": "KY",
            "postal_code": "427188709",
            "telephone_number": "270-858-3343"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIERTOX 2.0 INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-09-08",
        "last_updated": "2015-05-08",
        "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": "270-866-8854"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "KY",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Campbellsville, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2015; 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.