Provider Demographics
NPI:1902332463
Name:PREMIUM DIAGNOSTICS LLC
Entity Type:Organization
Organization Name:PREMIUM DIAGNOSTICS LLC
Other - Org Name:PREMIUM DIAGNOSTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ARUN
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMABADRAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-379-3084
Mailing Address - Street 1:425 S KINGS AVE
Mailing Address - Street 2:STE 102
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-5919
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2664 CYPRESS RIDGE BLVD
Practice Address - Street 2:STE 101
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-6325
Practice Address - Country:US
Practice Address - Phone:813-379-3084
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-03
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory