Basic Information
Provider Information
NPI: 1598427486
EntityType: 2
ReplacementNPI:  
OrganizationName: A NEW START - LABS
LastName:  
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MiddleName:  
NamePrefix:  
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Credential:  
OtherOrganizationName:  
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Mailing Information
Address1: 222 PHILLIP STONE WAY
Address2:  
City: CENTRAL CITY
State: KY
PostalCode: 423301929
CountryCode: US
TelephoneNumber: 2707543494
FaxNumber: 2707543499
Practice Location
Address1: 222 PHILLIP STONE WAY
Address2:  
City: CENTRAL CITY
State: KY
PostalCode: 423301929
CountryCode: US
TelephoneNumber: 2707543494
FaxNumber: 2707543499
Other Information
ProviderEnumerationDate: 10/08/2021
LastUpdateDate: 10/08/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: DUKES
AuthorizedOfficialFirstName: TIMOTHY
AuthorizedOfficialMiddleName: R
AuthorizedOfficialTitleorPosition: CEO/PRESIDENT
AuthorizedOfficialTelephone: 2707543494
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: MR.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 10/07/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
291U00000X  Y LaboratoriesClinical Medical Laboratory 

No ID Information.


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