NPIMap

Organization Active NPI

Premier Mobile Lab LLC

  • Clinical Medical Laboratory
  • Las Cruces, NM
National Provider Identifier
1740744614
Registry record updated Jan 25, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
Legal business name
PREMIER MOBILE LAB LLC
Practice address
383 Fossil View Rd
Las Cruces, NM 88007-7176
Phone
(575) 520-3254
NPI assigned
Jan 25, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 25, 2019

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

Authorized official

Name
Randall Dean Wilcox, PHLEBOTOMYNPI 1144592304
Title
Ceo
Phone
(575) 520-3254

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X
Clinical Medical Laboratory 291U00000X Primary
Point of Service 305S00000X
Mental Illness Intermediate Care Facility 310500000X
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy 332800000X

Addresses

Primary practice location

383 Fossil View Rd
Las Cruces, NM 88007-7176

Mailing address

PO Box 155
Radium Springs, NM 88054-0155
Phone (575) 520-3254

Other identifiers 1

IdentifierTypeStateIssuer
246RP1900XMedicaidNM

Other names 1

  • Premier Mobile Lab LLC Former legal business name

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1548374400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1548374400000",
    "number": "1740744614",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 155",
            "city": "RADIUM SPRINGS",
            "state": "NM",
            "postal_code": "880540155",
            "telephone_number": "575-520-3254"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "383 FOSSIL VIEW RD",
            "city": "LAS CRUCES",
            "state": "NM",
            "postal_code": "880077176",
            "telephone_number": "575-520-3254"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER MOBILE LAB LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-01-25",
        "last_updated": "2019-01-25",
        "status": "A",
        "authorized_official_last_name": "WILCOX",
        "authorized_official_first_name": "RANDALL",
        "authorized_official_middle_name": "DEAN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "575-520-3254",
        "authorized_official_credential": "PHLEBOTOMY"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "305S00000X",
            "taxonomy_group": "",
            "desc": "Point of Service",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "310500000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Mental Illness",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332800000X",
            "taxonomy_group": "",
            "desc": "Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "246RP1900X",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Premier Mobile Lab LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Las Cruces, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.