Organization
LIFEPLEX DIAGNOSTIC CENTER, L.L.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BYRON M HOLM JR. M.D. (MEMBER)
(574) 936-7777
Entity
Organization
Contact information
Practice address
2855 MILLER DR, SUITE 113, PLYMOUTH, IN 46563-8091
(574) 941-1090
Mailing address
2855 MILLER DR, SUITE 113, PLYMOUTH, IN 46563-8091
(574) 941-1090
Taxonomy
Speciality
Code
Description
License number
State
261QR0200X
Radiology Clinic/Center
Primary
—
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200882130
—
IN
Enumeration date
08/21/2007
Last updated
09/08/2008
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