Provider Demographics
NPI:1851912109
Name:OHIO VALLEY REFERENCE LAB
Entity Type:Organization
Organization Name:OHIO VALLEY REFERENCE LAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:HERN
Authorized Official - Suffix:
Authorized Official - Credentials:MSN RN
Authorized Official - Phone:937-717-2262
Mailing Address - Street 1:100 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45502-1312
Mailing Address - Country:US
Mailing Address - Phone:937-521-3900
Mailing Address - Fax:937-521-3910
Practice Address - Street 1:140 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45502-1368
Practice Address - Country:US
Practice Address - Phone:937-521-3900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OHIO VALLEY MEDICAL CENTER, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-04-28
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory