Provider Demographics
NPI:1780451435
Name:KENTUCKY CHRISTIAN LAB SERVICES LLC
Entity type:Organization
Organization Name:KENTUCKY CHRISTIAN LAB SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:DEERE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-371-2369
Mailing Address - Street 1:263 HUNTSVILLE QUALITY RD STE B
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42261-7395
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:263 HUNTSVILLE QUALITY RD STE B
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:KY
Practice Address - Zip Code:42261-7395
Practice Address - Country:US
Practice Address - Phone:270-516-1601
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-04
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory