Healthcare Provider Details

I. General information

NPI: 1497871263
Provider Name (Legal Business Name): OH MUHLENBERG, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 08/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 HOPKINSVILLE ST
GREENVILLE KY
42345-1124
US

IV. Provider business mailing address

440 HOPKINSVILLE ST P.O. BOX 387
GREENVILLE KY
42345-1124
US

V. Phone/Fax

Practice location:
  • Phone: 270-338-8000
  • Fax: 270-338-8278
Mailing address:
  • Phone: 270-338-8000
  • Fax: 270-338-8278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number100344
License Number StateKY

VIII. Authorized Official

Name: MR. JOHN HACKBARTH
Title or Position: TREASURER
Credential:
Phone: 270-417-4813