Provider Demographics
NPI:1265620223
Name:COMBINED PHYSICIANS LAB LLC
Entity type:Organization
Organization Name:COMBINED PHYSICIANS LAB LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-353-8464
Mailing Address - Street 1:3945 SIMPSON LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-9113
Mailing Address - Country:US
Mailing Address - Phone:859-353-8464
Mailing Address - Fax:855-704-1599
Practice Address - Street 1:3945 SIMPSON LN
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-9113
Practice Address - Country:US
Practice Address - Phone:859-353-8464
Practice Address - Fax:855-704-1599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-04
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
220001795OtherRRMC
KY37901212Medicaid
000000061984OtherBLUECROSS BLUESHIELD
4003301Medicare PIN