Organization
RENEW LABS, LLC
Active
Other names
Renew Labs
Organization subpart
No
Provider details
NPI number
Authorized official
MR. EUGENE SISCO III (MANAGING MEMBER)
(606) 653-1503
Entity
Organization
Contact information
Practice address
286 US HIGHWAY 23 N, PRESTONSBURG, KY 41653-8732
(606) 653-1503
Mailing address
400 VENTERS LANE, PIKEVILLE, KY 41501
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
18D2090590
CLIA NUMBER
—
01
—
291U0000X
TAXONOMY
—
05
—
7100331250
—
KY
Enumeration date
11/28/2014
Last updated
02/25/2019
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