Provider Demographics
NPI:1427614551
Name:FOUNTAIN POINT LABORATORY LLC
Entity type:Organization
Organization Name:FOUNTAIN POINT LABORATORY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:GEBHARDT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-844-8000
Mailing Address - Street 1:3901 W NORFOLK AVE STE D
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-9211
Mailing Address - Country:US
Mailing Address - Phone:402-844-8000
Mailing Address - Fax:
Practice Address - Street 1:3901 W NORFOLK AVE STE E
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-9211
Practice Address - Country:US
Practice Address - Phone:402-844-8011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-14
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory