Healthcare Provider Details

I. General information

NPI: 1356831069
Provider Name (Legal Business Name): BKC LABORATORY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2018
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1065 DELAWARE AVE STE A
MARION OH
43302-6461
US

IV. Provider business mailing address

1065 DELAWARE AVE STE A
MARION OH
43302-6461
US

V. Phone/Fax

Practice location:
  • Phone: 740-387-7246
  • Fax: 740-387-7244
Mailing address:
  • Phone: 740-387-7246
  • Fax: 740-387-7244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number35080847
License Number StateOH

VIII. Authorized Official

Name: ADIL OMAR KATABAY
Title or Position: OWNER/M.D.
Credential: M.D.
Phone: 614-738-4128