Provider Demographics
NPI:1801142435
Name:COMPLIANCE ADVANTAGE LLC
Entity type:Organization
Organization Name:COMPLIANCE ADVANTAGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEETS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-881-3131
Mailing Address - Street 1:232 NORTH PLAZA DRIVE
Mailing Address - Street 2:
Mailing Address - City:NICHOLASVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40356-8060
Mailing Address - Country:US
Mailing Address - Phone:859-881-3131
Mailing Address - Fax:859-881-3133
Practice Address - Street 1:232 N PLAZA DR
Practice Address - Street 2:
Practice Address - City:NICHOLASVILLE
Practice Address - State:KY
Practice Address - Zip Code:40356-2511
Practice Address - Country:US
Practice Address - Phone:859-881-3131
Practice Address - Fax:859-881-3133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYK085050OtherMEDICARE
KY7100262470Medicaid
KY7100262470Medicaid