Healthcare Provider Details

I. General information

NPI: 1205839610
Provider Name (Legal Business Name): KILBOURNE MEDICAL LABORATORIES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 06/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

665 OHIO PIKE
CINCINNATI OH
45245-2117
US

IV. Provider business mailing address

665 OHIO PIKE
CINCINNATI OH
45245-2117
US

V. Phone/Fax

Practice location:
  • Phone: 513-752-7300
  • Fax: 513-752-7601
Mailing address:
  • Phone: 513-752-7300
  • Fax: 513-752-7601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number36D0346978
License Number StateOH

VIII. Authorized Official

Name: CINDY SMOTHERMAN
Title or Position: BILLING MANAGER
Credential:
Phone: 513-752-7300