=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447462551
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CENTRAL LAB SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/03/2007
-----------------------------------------------------
Last Update Date | 04/20/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 411 CENTRAL AVE SUITE 14
-----------------------------------------------------
City | SOUTH WILLIAMSON
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 41503-4149
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-237-1050
-----------------------------------------------------
Fax | 606-237-0401
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 411 CENTRAL AVE SUITE 14
-----------------------------------------------------
City | SOUTH WILLIAMSON
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 41503-4149
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-237-1050
-----------------------------------------------------
Fax | 606-237-0401
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. BETTY KARNES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 606-237-0105
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------