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General NPI Number Information
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NPI Number | 1679698633
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Entity Type | Organization
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Legal Business Name | MOLECULAR DIAGNOSTICS LABORATORIES INC
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Dates
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Enumeration Date | 03/20/2007
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Last Update Date | 01/22/2014
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Provider Practice Location Address
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Address Line | 632 RUSSELL STREET
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City | COVINGTON
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State | KY
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Zip | 41011-2353
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Country | US
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Telephone | 855-841-7111
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Fax | 859-581-4086
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Provider Business Mailing Address
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Address Line | 632 RUSSELL STREET
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City | COVINGTON
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State | KY
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Zip | 41011-2353
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Country | US
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Telephone | 855-841-7111
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Fax | 859-581-4086
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Authorized Official
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Title or Position | LABORATORY DIRECTOR
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Name | MR. FRANCIS GENBAUFFE JR.
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Credential | PH.D.
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Telephone | 855-841-7111
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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 | CLIA 18D1100471
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License Number State | KY
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