Provider Demographics
NPI:1801368998
Name:LUCID DIAGNOSTICS LABS LLC
Entity Type:Organization
Organization Name:LUCID DIAGNOSTICS LABS LLC
Other - Org Name:SV DIAGNOSTIC LAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MADDY
Authorized Official - Middle Name:
Authorized Official - Last Name:NARAHARI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-395-7304
Mailing Address - Street 1:8628 INDUSTRIAL PARKWAY
Mailing Address - Street 2:UNIT E, SUITE 107
Mailing Address - City:PLAIN CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43064-8069
Mailing Address - Country:US
Mailing Address - Phone:937-421-8867
Mailing Address - Fax:
Practice Address - Street 1:8628 INDUSTRIAL PARKWAY
Practice Address - Street 2:UNIT E, SUITE 107
Practice Address - City:PLAIN CITY
Practice Address - State:OH
Practice Address - Zip Code:43064-8069
Practice Address - Country:US
Practice Address - Phone:937-421-8867
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-30
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory