Provider Demographics
NPI:1417193343
Name:THE SPRINGS MEDICAL LABORATORY,LLC
Entity Type:Organization
Organization Name:THE SPRINGS MEDICAL LABORATORY,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:E
Authorized Official - Last Name:MCNULTY
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:270-683-9771
Mailing Address - Street 1:2200 E PARRISH AVE
Mailing Address - Street 2:BUILDING 1 SUITE 102
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-1449
Mailing Address - Country:US
Mailing Address - Phone:270-683-9771
Mailing Address - Fax:
Practice Address - Street 1:2200 E PARRISH AVE
Practice Address - Street 2:BUILDING 1 SUITE 102
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-1449
Practice Address - Country:US
Practice Address - Phone:270-683-9771
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-23
Last Update Date:2009-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY200305291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY200305OtherSTATE LICENSE
KY18D1092600OtherCLIA
KY200305OtherSTATE LICENSE