Provider Demographics
NPI:1518934322
Name:OWENSBORO MEDICAL CENTER LABORATORY, INC
Entity Type:Organization
Organization Name:OWENSBORO MEDICAL CENTER LABORATORY, INC
Other - Org Name:OWENSBORO MEDICAL CENTER LAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:T
Authorized Official - Last Name:HACKBARTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-691-8214
Mailing Address - Street 1:26254 NETWORK PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-1262
Mailing Address - Country:US
Mailing Address - Phone:270-417-6500
Mailing Address - Fax:270-417-6509
Practice Address - Street 1:1201 PLEASANT VALLEY ROAD
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-3258
Practice Address - Country:US
Practice Address - Phone:270-684-1940
Practice Address - Fax:270-684-0494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-01
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY37901360Medicaid
KY37901360Medicaid