Provider Demographics
NPI:1659588705
Name:RTG MEDICAL
Entity Type:Organization
Organization Name:RTG MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL LABORATORY TECHNICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:WADE
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:MLT
Authorized Official - Phone:859-757-5796
Mailing Address - Street 1:437 HIGHWAY AVE
Mailing Address - Street 2:
Mailing Address - City:LUDLOW
Mailing Address - State:KY
Mailing Address - Zip Code:41016-1688
Mailing Address - Country:US
Mailing Address - Phone:859-757-5796
Mailing Address - Fax:
Practice Address - Street 1:3028 PADDOCK ROAD
Practice Address - Street 2:APARTMENT 113A
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124
Practice Address - Country:US
Practice Address - Phone:859-757-5796
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory