Healthcare Provider Details

I. General information

NPI: 1205666344
Provider Name (Legal Business Name): WI CARE CLINICAL LABS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2024
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 VICTORY PKWY STE 501
CINCINNATI OH
45206-2837
US

IV. Provider business mailing address

660 BRANDTLY RIDGE DR
COVINGTON KY
41015-4228
US

V. Phone/Fax

Practice location:
  • Phone: 513-322-4052
  • Fax: 513-279-9447
Mailing address:
  • Phone: 603-331-5680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: DR. PETER JOHN LOGA
Title or Position: DIRECTOR
Credential: PHD, MS, MLS(ASCP)
Phone: 603-331-5680