Provider Demographics
NPI:1992041214
Name:OHIO RIVER LABORATORIES, LLC
Entity Type:Organization
Organization Name:OHIO RIVER LABORATORIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MITALI
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-541-7363
Mailing Address - Street 1:OHIO RIVER LABORATORIES, LLC
Mailing Address - Street 2:6776 SOUTHWEST FREEWAY STE 610
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074
Mailing Address - Country:US
Mailing Address - Phone:281-617-7586
Mailing Address - Fax:
Practice Address - Street 1:OHIO RIVER LABORATORIES, LLC
Practice Address - Street 2:1841 MASON MONTGOMERY RD, UNIT 1C
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45249
Practice Address - Country:US
Practice Address - Phone:832-541-7363
Practice Address - Fax:888-409-5754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-13
Last Update Date:2020-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36D2050451291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH36D2050451OtherCLIA