Provider Demographics
NPI:1285006643
Name:TENNESSEE FERTILITY LABORATORY, LLC
Entity Type:Organization
Organization Name:TENNESSEE FERTILITY LABORATORY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:KEHOE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-300-1123
Mailing Address - Street 1:5000 MERIDIAN BLVD STE 250
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-6681
Mailing Address - Country:US
Mailing Address - Phone:615-550-4922
Mailing Address - Fax:615-550-4922
Practice Address - Street 1:5000 MERIDIAN BLVD STE 250
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-6681
Practice Address - Country:US
Practice Address - Phone:615-721-6250
Practice Address - Fax:615-721-6251
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TENNESSEE FERTILITY INSTITUTE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-10-26
Last Update Date:2019-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory