Provider Demographics
NPI:1710658497
Name:SYNCHRONY LAB SERVICES, LLC
Entity Type:Organization
Organization Name:SYNCHRONY LAB SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF ADMINISTRATION
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:TRENT
Authorized Official - Last Name:BLACKETER
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:502-266-2529
Mailing Address - Street 1:3600 CHAMBERLAIN LN STE 336
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40241-1997
Mailing Address - Country:US
Mailing Address - Phone:502-266-2529
Mailing Address - Fax:
Practice Address - Street 1:3600 CHAMBERLAIN LN STE 336
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-1997
Practice Address - Country:US
Practice Address - Phone:502-266-2529
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-23
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory