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General NPI Number Information
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NPI Number | 1093140618
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Entity Type | Organization
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Legal Business Name | BLUEWATER TOXICOLOGY LLC
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Dates
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Enumeration Date | 09/13/2013
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Last Update Date | 05/17/2021
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Provider Practice Location Address
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Address Line | 221 S BARDSTOWN RD
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City | MT WASHINGTON
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State | KY
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Zip | 40047-7248
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Country | US
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Telephone | 502-538-2980
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Fax | 502-538-0352
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Provider Business Mailing Address
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Address Line | 221 S BARDSTOWN RD
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City | MT WASHINGTON
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State | KY
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Zip | 40047-7248
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Country | US
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Telephone | 502-538-2980
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Fax | 502-538-0352
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | MS. JENNIFER L BOLUS
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Credential |
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Telephone | 502-538-2980
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 18D2063609
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License Number State | KY
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