Provider Demographics
NPI:1205839610
Name:KILBOURNE MEDICAL LABORATORIES INC
Entity Type:Organization
Organization Name:KILBOURNE MEDICAL LABORATORIES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:SMOTHERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-752-7300
Mailing Address - Street 1:665 OHIO PIKE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45245-2117
Mailing Address - Country:US
Mailing Address - Phone:513-752-7300
Mailing Address - Fax:513-752-7601
Practice Address - Street 1:665 OHIO PIKE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45245-2117
Practice Address - Country:US
Practice Address - Phone:513-752-7300
Practice Address - Fax:513-752-7601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-31
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36D0346978291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY37902368Medicaid
OH000000272341OtherANTHEM FEDERAL
OH0592505Medicaid
IN200232160AMedicaid
OH3500134OtherUNITED HEALTHCARE
IN200232160AMedicaid
OH=========002OtherTEAMCARE
OH0592505Medicaid
OH3682811Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
KY37902368Medicaid