Healthcare Provider Details

I. General information

NPI: 1316494081
Provider Name (Legal Business Name): OLIVER WINSTON LAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2016
Last Update Date: 01/31/2023
Certification Date: 01/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1618 HARRODSBURG RD
LEXINGTON KY
40504-3706
US

IV. Provider business mailing address

1618 HARRODSBURG RD
LEXINGTON KY
40504-3706
US

V. Phone/Fax

Practice location:
  • Phone: 859-444-5790
  • Fax: 859-444-5791
Mailing address:
  • Phone: 859-444-5790
  • Fax: 859-444-5791

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number State

VIII. Authorized Official

Name: DHAVAL PATEL
Title or Position: PARTNER
Credential:
Phone: 859-444-5790