Provider Demographics
NPI:1356831069
Name:BKC LABORATORY LLC
Entity Type:Organization
Organization Name:BKC LABORATORY LLC
Other - Org Name:BKC PAIN SPECIALISTS LLC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/M.D.
Authorized Official - Prefix:
Authorized Official - First Name:ADIL
Authorized Official - Middle Name:OMAR
Authorized Official - Last Name:KATABAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:614-738-4128
Mailing Address - Street 1:1065 DELAWARE AVE STE A
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-6461
Mailing Address - Country:US
Mailing Address - Phone:740-387-7246
Mailing Address - Fax:740-387-7244
Practice Address - Street 1:1065 DELAWARE AVE STE A
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-6461
Practice Address - Country:US
Practice Address - Phone:740-387-7246
Practice Address - Fax:740-387-7244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-17
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35080847261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0127499Medicaid
OH2318414Medicaid