MEDICARE: C19 LABS 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

General Provider Information

NPI Number	:	1952169021
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	C19 LABS LLC

Provider Business Mailing Address
First Line	:	1718 ALEXANDRIA DR STE 300
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40504-3144
Country	:	US
Telephone Number	:	859-215-7956
Fax Number	:	859-215-7656

Provider Business Practice Location Address
First Line	:	1718 ALEXANDRIA DR STE 300
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40504-3144
Country	:	US
Telephone Number	:	859-215-7956
Fax Number	:	859-215-7656

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ANDREW TAYLOR BRIGHT
Credential	:	PHD
Telephone Number	:	609-977-0604

Provider Enumeration Date	:	03/12/2024
Last Update Date	:	01/30/2025

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