Provider Demographics
NPI:1447581558
Name:NEXUS LAB INC
Entity Type:Organization
Organization Name:NEXUS LAB INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:BERTRAM
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:270-866-8881
Mailing Address - Street 1:92 JOE T PETTY DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:RUSSELL SPRINGS
Mailing Address - State:KY
Mailing Address - Zip Code:42642-8544
Mailing Address - Country:US
Mailing Address - Phone:270-866-8896
Mailing Address - Fax:
Practice Address - Street 1:1463 CAMPBELLSVILLE RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:KY
Practice Address - Zip Code:42728-2263
Practice Address - Country:US
Practice Address - Phone:270-384-9934
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-29
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100118690Medicaid
KY01467Medicare PIN