Provider Demographics
NPI:1821046210
Name:PHYSICIANS PREFERRED LABORATORY LTD
Entity type:Organization
Organization Name:PHYSICIANS PREFERRED LABORATORY LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MICAH
Authorized Official - Middle Name:LEA
Authorized Official - Last Name:CARDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-355-7286
Mailing Address - Street 1:PO BOX 50117
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79159-0117
Mailing Address - Country:US
Mailing Address - Phone:806-355-7286
Mailing Address - Fax:
Practice Address - Street 1:3501 S SONCY RD
Practice Address - Street 2:SUITE 116
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79119-6407
Practice Address - Country:US
Practice Address - Phone:806-355-7286
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX090097901Medicaid