Provider Demographics
NPI:1063695021
Name:RCH JAMESTOWN HEALTHCARE LAB
Entity type:Organization
Organization Name:RCH JAMESTOWN HEALTHCARE LAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEMMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-866-4141
Mailing Address - Street 1:PO BOX 1610
Mailing Address - Street 2:
Mailing Address - City:RUSSELL SPRINGS
Mailing Address - State:KY
Mailing Address - Zip Code:42642-1610
Mailing Address - Country:US
Mailing Address - Phone:270-866-4141
Mailing Address - Fax:
Practice Address - Street 1:1417 N MAIN ST
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:KY
Practice Address - Zip Code:42629
Practice Address - Country:US
Practice Address - Phone:270-866-4141
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY37000882Medicaid
KY37000882Medicaid