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General NPI Number Information
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NPI Number | 1992490320
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Entity Type | Organization
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Legal Business Name | C19 LABS LLC
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Dates
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Enumeration Date | 04/11/2023
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Last Update Date | 01/30/2025
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Provider Practice Location Address
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Address Line | 800 CORPORATE DR STE 130
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City | LEXINGTON
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State | KY
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Zip | 40503-5402
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Country | US
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Telephone | 859-215-7964
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Fax | 859-376-1216
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Provider Business Mailing Address
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Address Line | 838 E HIGH ST # 202
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City | LEXINGTON
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State | KY
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Zip | 40502-2107
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Country | US
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Telephone | 859-215-7964
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Fax | 859-376-1216
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Authorized Official
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Title or Position | PRESIDENT
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Name | ANDREW TAYLOR BRIGHT
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Credential | PHD
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Telephone | 609-977-0604
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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 |
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License Number State |
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