Provider Demographics
NPI:1932456795
Name:NEXUS LAB 2.0, LLC
Entity Type:Organization
Organization Name:NEXUS LAB 2.0, LLC
Other - Org Name:NEXUS CHICAGO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNCAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-368-9504
Mailing Address - Street 1:PO BOX 1038
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:KY
Mailing Address - Zip Code:40602-1038
Mailing Address - Country:US
Mailing Address - Phone:502-226-3858
Mailing Address - Fax:502-223-9829
Practice Address - Street 1:2835 N SHEFFIELD AVE
Practice Address - Street 2:SUITE 312
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-5081
Practice Address - Country:US
Practice Address - Phone:270-866-4931
Practice Address - Fax:773-904-7240
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PREMIERTOX 2.0, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-08-12
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory