Provider Demographics
NPI:1821360017
Name:VERRALAB JA LLC
Entity Type:Organization
Organization Name:VERRALAB JA LLC
Other - Org Name:BIOTAP MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:502-566-3588
Mailing Address - Street 1:716 W MAIN ST STE 100A
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-2777
Mailing Address - Country:US
Mailing Address - Phone:502-566-3588
Mailing Address - Fax:502-566-0089
Practice Address - Street 1:716 W MAIN ST STE 100A
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-2777
Practice Address - Country:US
Practice Address - Phone:502-566-3588
Practice Address - Fax:502-561-0089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-02
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL180323Medicaid
AL180852Medicaid
AZ922818Medicaid
WV1821360017Medicaid
MS01370700Medicaid
OH0145798Medicaid
KS201127880AMedicaid
AR210097709Medicaid
GA003162261AMedicaid
SCL00443Medicaid
MO1821360017Medicaid
TN1533914Medicaid
TX3255051Medicaid
FL016955600Medicaid
IN201184500AMedicaid
NM22029532Medicaid
KY7100223830Medicaid
MO1821360017Medicaid
KYK047561Medicare PIN