MEDICARE: KILBOURNE MEDICAL LABORATORIES INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory	36D0346978	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	000000272341	OTHER	OH	ANTHEM FEDERAL
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	3500134	OTHER	OH	UNITED HEALTHCARE

General Provider Information

NPI Number	:	1205839610
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KILBOURNE MEDICAL LABORATORIES INC

Provider Business Mailing Address
First Line	:	665 OHIO PIKE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45245-2117
Country	:	US
Telephone Number	:	513-752-7300
Fax Number	:	513-752-7601

Provider Business Practice Location Address
First Line	:	665 OHIO PIKE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45245-2117
Country	:	US
Telephone Number	:	513-752-7300
Fax Number	:	513-752-7601

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	CINDY SMOTHERMAN
Credential	:
Telephone Number	:	513-752-7300

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	06/04/2008

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