Healthcare Provider Details

I. General information

NPI: 1629476700
Provider Name (Legal Business Name): THE INFINITY CENTER LAB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2014
Last Update Date: 08/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 17TH ST
ASHLAND KY
41101-7628
US

IV. Provider business mailing address

340 17TH ST
ASHLAND KY
41101-7628
US

V. Phone/Fax

Practice location:
  • Phone: 606-420-4070
  • Fax: 606-420-4071
Mailing address:
  • Phone: 606-420-4070
  • Fax: 606-420-4071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number
License Number State

VIII. Authorized Official

Name: WILL CARTER
Title or Position: OWNER
Credential:
Phone: 606-420-4070