Provider Demographics
NPI:1689876690
Name:COOPERATIVE HEALTH SERVICES, INC
Entity Type:Organization
Organization Name:COOPERATIVE HEALTH SERVICES, INC
Other - Org Name:WESTERN KENTUCKY RHEUMATOLOGY CENTER LABORATORY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:T
Authorized Official - Last Name:HACKBARTH
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:270-688-2114
Mailing Address - Street 1:815 E PARRISH AVE STE 230
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-3222
Mailing Address - Country:US
Mailing Address - Phone:270-688-1200
Mailing Address - Fax:270-688-1204
Practice Address - Street 1:815 E PARRISH AVE STE 230
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-3222
Practice Address - Country:US
Practice Address - Phone:270-688-1200
Practice Address - Fax:270-688-1204
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COOPERATIVE HEALTH SERVICES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-06-01
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY200254291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000518826OtherANTHEM LAB GROUP # - CHS
KY000000518826OtherANTHEM LAB GROUP # - CHS