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NPI Code Detail

MEDICARE: NEXUS LAB 2.0 LLC

MEDICARE: NEXUS LAB 2.0 LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1291U00000XClinical Medical Laboratory

General Provider Information

NPI Number : 1760770127
Entity Type Code : Organization
Provider Name (Legal Business Name) : NEXUS LAB 2.0 LLC
Provider Business Mailing Address
First Line : PO BOX 1038
Second Line :
City : FRANKFORT
State : KY
Zip : 40602-1038
Country : US
Telephone Number : 502-226-3858
Fax Number : 502-223-9829
Provider Business Practice Location Address
First Line : 400 N DIXIE HWY
Second Line :
City : CAVE CITY
State : KY
Zip : 42127-9546
Country : US
Telephone Number : 270-792-3902
Fax Number : 270-773-3738
Authorized Official
Title or Position : MANAGING MEMBER
Name : ROBERT L. BERTRAM
Credential : D.O.
Telephone Number : 270-866-8881
Provider Enumeration Date : 07/19/2011
Last Update Date : 07/19/2011

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