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NPI Code Detail

MEDICARE: NEXUS LAB, INC.

MEDICARE: NEXUS LAB, 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
1291U00000XClinical Medical Laboratory200321KY

General Provider Information

NPI Number : 1417266875
Entity Type Code : Organization
Provider Name (Legal Business Name) : NEXUS LAB, INC.
Provider Business Mailing Address
First Line : 92 JOE T PETTY DR
Second Line :
City : RUSSELL SPRINGS
State : KY
Zip : 42642-8544
Country : US
Telephone Number : 270-866-8881
Fax Number : 270-866-8849
Provider Business Practice Location Address
First Line : 400 N DIXIE HWY
Second Line :
City : CAVE CITY
State : KY
Zip : 42127-9546
Country : US
Telephone Number : 270-792-3902
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : ROBERT L. BERTRAM
Credential : D.O.
Telephone Number : 270-866-8881
Provider Enumeration Date : 10/04/2010
Last Update Date : 10/04/2010

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