Provider Demographics
NPI:1932461738
Name:LABEXPRESS MEDILAB LLC
Entity Type:Organization
Organization Name:LABEXPRESS MEDILAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RON
Authorized Official - Middle Name:
Authorized Official - Last Name:COBURN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-421-9596
Mailing Address - Street 1:2720 OLD ROSEBUD RD
Mailing Address - Street 2:2ND FLOOR, STE 280
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-8004
Mailing Address - Country:US
Mailing Address - Phone:877-294-1621
Mailing Address - Fax:866-897-2926
Practice Address - Street 1:2720 OLD ROSEBUD RD
Practice Address - Street 2:2ND FLOOR, STE 280
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-8004
Practice Address - Country:US
Practice Address - Phone:877-294-1621
Practice Address - Fax:866-897-2926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-08
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY200335291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100226840Medicaid
KYK071070Medicare PIN