Organization
BLUEWATER TOXICOLOGY LLC
Active
Other names
Bluewater Toxicology
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JENNIFER L BOLUS (MANAGING PARTNER)
(502) 538-2980
Entity
Organization
Contact information
Practice address
221 S BARDSTOWN RD, MT WASHINGTON, KY 40047-7248
(502) 538-2980
(502) 538-0352
Mailing address
221 S BARDSTOWN RD, MT WASHINGTON, KY 40047-7248
(502) 538-2980
(502) 538-0352
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
18D2063609
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0156117
—
OH
01
—
18D2063609
CLIA # 18D2063609
KY
01
—
200358
COMMONWEALTH OF KENTUCKY MEDICAL LABORATORY
KY
01
—
24777
COLA #
KY
05
—
7100337990
—
KY
05
—
Q045535
—
TN
Enumeration date
09/13/2013
Last updated
05/17/2021
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