MEDICARE: PINNACLE LABORATORIES, LLC

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	29531	KY

General Provider Information

NPI Number	:	1578806576
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PINNACLE LABORATORIES, LLC

Provider Business Mailing Address
First Line	:	2375 PROFESSIONAL HEIGHTS DR
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40503-3040
Country	:	US
Telephone Number	:	859-554-5181
Fax Number	:

Provider Business Practice Location Address
First Line	:	2375 PROFESSIONAL HEIGHTS DR
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40503-3040
Country	:	US
Telephone Number	:	859-554-5181
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SHANE E BEALL
Credential	:
Telephone Number	:	859-494-8003

Provider Enumeration Date	:	03/28/2013
Last Update Date	:	03/28/2013

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