Provider Demographics
NPI:1407153810
Name:LAB EXPRESS LTD, PLLC
Entity Type:Organization
Organization Name:LAB EXPRESS LTD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RON
Authorized Official - Middle Name:H
Authorized Official - Last Name:COBURN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-421-9596
Mailing Address - Street 1:2720 OLD ROSEBUD RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-8004
Mailing Address - Country:US
Mailing Address - Phone:859-421-9596
Mailing Address - Fax:866-897-2926
Practice Address - Street 1:2720 OLD ROSEBUD RD
Practice Address - Street 2:STE 280
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-8004
Practice Address - Country:US
Practice Address - Phone:859-421-9596
Practice Address - Fax:866-897-2926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-21
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD42643291U00000X
TNMD19665291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103G698552Medicare UPIN