Provider Demographics
NPI:1528710779
Name:PREMIER CHOICE MEDICAL LAB PLLC
Entity type:Organization
Organization Name:PREMIER CHOICE MEDICAL LAB PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:SHELIA
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:APRN FNP-BC
Authorized Official - Phone:214-241-9782
Mailing Address - Street 1:951 YORK DR STE 102
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-2052
Mailing Address - Country:US
Mailing Address - Phone:214-241-9782
Mailing Address - Fax:
Practice Address - Street 1:3701 S LANCASTER RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75216-5630
Practice Address - Country:US
Practice Address - Phone:817-217-1880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-19
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty