Provider Demographics
NPI:1992047179
Name:PREMIER INTEGRITY SOLUTIONS INC
Entity type:Organization
Organization Name:PREMIER INTEGRITY SOLUTIONS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:S
Authorized Official - Last Name:RAGLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-866-3144
Mailing Address - Street 1:PO BOX 2279
Mailing Address - Street 2:
Mailing Address - City:RUSSELL SPRINGS
Mailing Address - State:KY
Mailing Address - Zip Code:42642-2279
Mailing Address - Country:US
Mailing Address - Phone:270-866-3762
Mailing Address - Fax:270-866-3793
Practice Address - Street 1:660 LAKEWAY DR
Practice Address - Street 2:SUITE B
Practice Address - City:RUSSELL SPRINGS
Practice Address - State:KY
Practice Address - Zip Code:42642-4179
Practice Address - Country:US
Practice Address - Phone:270-866-3762
Practice Address - Fax:270-866-3793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-26
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY200344291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810026106Medicaid
OH0158089Medicaid
KY7100245710Medicaid
KYK081860Medicare PIN