Healthcare Provider Details

I. General information

NPI: 1801368998
Provider Name (Legal Business Name): LUCID DIAGNOSTICS LABS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2018
Last Update Date: 04/19/2024
Certification Date: 04/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8628 INDUSTRIAL PARKWAY UNIT E, SUITE 107
PLAIN CITY OH
43064-8069
US

IV. Provider business mailing address

8628 INDUSTRIAL PARKWAY UNIT E, SUITE 107
PLAIN CITY OH
43064-8069
US

V. Phone/Fax

Practice location:
  • Phone: 937-421-8867
  • Fax:
Mailing address:
  • Phone: 937-421-8867
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. MADDY NARAHARI
Title or Position: OWNER
Credential:
Phone: 937-395-7304