Provider Demographics
NPI:1316968431
Name:MEDICAL ARTS LABORATORY, INC.
Entity type:Organization
Organization Name:MEDICAL ARTS LABORATORY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SARONDA
Authorized Official - Middle Name:G
Authorized Official - Last Name:GAYHEART
Authorized Official - Suffix:
Authorized Official - Credentials:MT(ASCP)
Authorized Official - Phone:859-623-3956
Mailing Address - Street 1:1110 LANCASTER RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-8792
Mailing Address - Country:US
Mailing Address - Phone:859-623-3956
Mailing Address - Fax:859-623-0272
Practice Address - Street 1:1110 LANCASTER RD
Practice Address - Street 2:SUITE 1
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-8792
Practice Address - Country:US
Practice Address - Phone:859-623-3956
Practice Address - Fax:859-623-0272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY200150291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000061994OtherUNICARE
KY37903739Medicaid
KY000000061994OtherANTHEM BC/BS
KY000000061994OtherKENTUCKY ACCESS
KY4010901Medicare ID - Type Unspecified