Organization
MID AMERICA CLINICAL LABORATORIES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DIANNE Z. VANNESS (C.E.O.)
(317) 803-1010
Entity
Organization
Contact information
Practice address
2560 N SHADELAND AVE, INDIANAPOLIS, IN 46219-1705
(317) 803-1010
(317) 803-0186
Mailing address
1907 W SYCAMORE ST, KOKOMO, IN 46901-5148
(765) 456-5341
(765) 456-5667
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
15D0358561
IN
Other
Enumeration date
12/11/2013
Last updated
04/30/2014
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