Provider Demographics
NPI:1992253249
Name:APOLLO LABORATORY SCIENCE AND TECHNOLOGY SERVICES
Entity type:Organization
Organization Name:APOLLO LABORATORY SCIENCE AND TECHNOLOGY SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING ADMINISTRATIVE
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:D
Authorized Official - Last Name:SHEETS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-320-0412
Mailing Address - Street 1:1718 ALEXANDRIA DR STE 300
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-3144
Mailing Address - Country:US
Mailing Address - Phone:859-320-0412
Mailing Address - Fax:888-977-1886
Practice Address - Street 1:1718 ALEXANDRIA DR STE 300
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-3144
Practice Address - Country:US
Practice Address - Phone:859-320-0412
Practice Address - Fax:888-977-1886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-15
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY200377291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100497050Medicaid
KYK226080OtherMEDICARE