Provider Demographics
NPI:1639554785
Name:KENTUCKY FERTILITY LABORATORY, LLC
Entity Type:Organization
Organization Name:KENTUCKY FERTILITY LABORATORY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF STRATEGY & PRODUCT OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:CABLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-550-4922
Mailing Address - Street 1:5000 MERIDIAN BLVD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-6667
Mailing Address - Country:US
Mailing Address - Phone:615-550-4922
Mailing Address - Fax:
Practice Address - Street 1:4612 CHAMBERLAIN LN
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-1071
Practice Address - Country:US
Practice Address - Phone:615-550-4900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KENTUCKY FERTILITY ASSOCIATES, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-07-29
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
291U00000X291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory