Provider Demographics
NPI:1699778498
Name:FIRST LAB, LLC
Entity type:Organization
Organization Name:FIRST LAB, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:FORCHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-528-9600
Mailing Address - Street 1:PO BOX 1450
Mailing Address - Street 2:
Mailing Address - City:CORBIN
Mailing Address - State:KY
Mailing Address - Zip Code:40702-1450
Mailing Address - Country:US
Mailing Address - Phone:606-523-1274
Mailing Address - Fax:606-528-3873
Practice Address - Street 1:2216 YOUNG DR
Practice Address - Street 2:STE 2
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40505-4220
Practice Address - Country:US
Practice Address - Phone:859-335-0970
Practice Address - Fax:606-528-3873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY200259291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY37000510Medicaid
KY800566OtherBLACK LUNG
KY000000297502OtherANTHEM PROVIDER ID
KY000000297502OtherANTHEM PROVIDER ID
KYP00025708Medicare ID - Type UnspecifiedMEDICARE TRAVELERS
KY4016101Medicare ID - Type UnspecifiedMEDICARE PROVIDER #