Organization
PHOENIX ENTERPRISE
Active
Other names
Phoenix Diagnostics
Organization subpart
No
Provider details
NPI number
Authorized official
STEVE NETHERTON (OFFICIAL)
(502) 551-9988
Entity
Organization
Contact information
Practice address
3191 BEAUMONT CENTRE CIR STE 150, LEXINGTON, KY 40513-1830
(859) 900-2668
Mailing address
300 W VINE ST STE 1408, LEXINGTON, KY 40507-1814
(859) 900-2668
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
18D2188408
CLIA
KY
01
—
200414
KENTCKY STATE LICENSE
KY
Enumeration date
08/04/2020
Last updated
08/04/2020
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