Provider Demographics
NPI:1447462551
Name:CENTRAL LAB SERVICES LLC
Entity type:Organization
Organization Name:CENTRAL LAB SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:
Authorized Official - Last Name:KARNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-237-0105
Mailing Address - Street 1:411 CENTRAL AVE
Mailing Address - Street 2:SUITE 14
Mailing Address - City:SOUTH WILLIAMSON
Mailing Address - State:KY
Mailing Address - Zip Code:41503-4149
Mailing Address - Country:US
Mailing Address - Phone:606-237-1050
Mailing Address - Fax:606-237-0401
Practice Address - Street 1:411 CENTRAL AVE
Practice Address - Street 2:SUITE 14
Practice Address - City:SOUTH WILLIAMSON
Practice Address - State:KY
Practice Address - Zip Code:41503-4149
Practice Address - Country:US
Practice Address - Phone:606-237-1050
Practice Address - Fax:606-237-0401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY5773670OtherCOVENTRY HEALTH
KY1196159OtherCHA HEALTH
KY000000531535OtherANTHEM BL CROSS BL SHIELD
WV3810009180Medicaid
KY=========OtherUMWA
KY=========OtherAETNA
WV3810009180Medicaid
KY=========Other4MOST
KY5773670OtherCOVENTRY HEALTH
KY1196159OtherCHA HEALTH
KY=========OtherTRICARE