MEDICARE: FIRST LAB, 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	200259	KY

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	800566	OTHER	KY	BLACK LUNG
3	000000297502	OTHER	KY	ANTHEM PROVIDER ID

General Provider Information

NPI Number	:	1699778498
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIRST LAB, LLC

Provider Business Mailing Address
First Line	:	PO BOX 1450
Second Line	:
City	:	CORBIN
State	:	KY
Zip	:	40702-1450
Country	:	US
Telephone Number	:	606-523-1274
Fax Number	:	606-528-3873

Provider Business Practice Location Address
First Line	:	2216 YOUNG DR
Second Line	:	STE 2
City	:	LEXINGTON
State	:	KY
Zip	:	40505-4220
Country	:	US
Telephone Number	:	859-335-0970
Fax Number	:	606-528-3873

Authorized Official
Title or Position	:	CEO
Name	:	TERRY FORCHT
Credential	:
Telephone Number	:	606-528-9600

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	08/22/2020

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Directions to “FIRST LAB, LLC ” Practice Location

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