Provider Demographics
NPI: | 1336371749 |
---|---|
Name: | LABORATORY AND BIODIAGNOSTICS, LLC |
Entity Type: | Organization |
Organization Name: | LABORATORY AND BIODIAGNOSTICS, LLC |
Other - Org Name: | LABDX |
Other - Org Type: | Other Name |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | MR |
Authorized Official - First Name: | ROBERT |
Authorized Official - Middle Name: | C |
Authorized Official - Last Name: | MUDD |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 859-368-8838 |
Mailing Address - Street 1: | PO BOX 11548 |
Mailing Address - Street 2: | |
Mailing Address - City: | LEXINGTON |
Mailing Address - State: | KY |
Mailing Address - Zip Code: | 40576-1548 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 859-368-8838 |
Mailing Address - Fax: | 859-368-8489 |
Practice Address - Street 1: | 2277 THUNDERSTICK DR |
Practice Address - Street 2: | |
Practice Address - City: | LEXINGTON |
Practice Address - State: | KY |
Practice Address - Zip Code: | 40505-9002 |
Practice Address - Country: | US |
Practice Address - Phone: | 859-368-8838 |
Practice Address - Fax: | 859-368-8489 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2009-08-18 |
Last Update Date: | 2009-08-18 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
KY | 200307 | 291U00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 291U00000X | Laboratories | Clinical Medical Laboratory |