Provider Demographics
NPI:1932236148
Name:MEDICAL LABORATORY CONSULTANTS, PLLC
Entity Type:Organization
Organization Name:MEDICAL LABORATORY CONSULTANTS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEWART
Authorized Official - Middle Name:E
Authorized Official - Last Name:WOLFSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-589-1980
Mailing Address - Street 1:221 S PRESTON ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1223
Mailing Address - Country:US
Mailing Address - Phone:502-589-1980
Mailing Address - Fax:502-589-1982
Practice Address - Street 1:221 S PRESTON ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1223
Practice Address - Country:US
Practice Address - Phone:502-589-1980
Practice Address - Fax:502-589-1982
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY200241291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY37000130Medicaid
KY000000061816OtherANTHEM BLUE CROSS
KY000000061816OtherKENTUCKY ACCESS
KY4015101Medicare PIN