Provider Demographics
NPI:1649332925
Name:PIKEVILLE MEDICAL BUILDING LAB., INC.
Entity type:Organization
Organization Name:PIKEVILLE MEDICAL BUILDING LAB., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-OPERATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:K
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:BSMT(ASCP)
Authorized Official - Phone:606-432-1266
Mailing Address - Street 1:PO BOX 2529
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41502-2529
Mailing Address - Country:US
Mailing Address - Phone:606-432-1266
Mailing Address - Fax:606-432-1944
Practice Address - Street 1:387 TOWN MOUNTAIN RD
Practice Address - Street 2:SUITE 203
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-1640
Practice Address - Country:US
Practice Address - Phone:606-432-1266
Practice Address - Fax:606-432-1944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY200148291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000190221OtherBC-BS PROVIDER NUMVER
4004601-5801OtherCOMMERCIAL CLAIM PROVIDER
KY37000197Medicaid
KY4015301Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER