Organization
TERRE HAUTE MEDICAL LABORATORY, INC
Active
Other names
MEDLAB
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WILLIAM D. DEPOND M.D. (PRESIDENT AND CHIEF MEDICAL OFFICER)
(812) 244-0100
Entity
Organization
Contact information
Practice address
1606 N 7TH STREET, TERRE HAUTE, IN 47804-2706
(812) 244-0100
(812) 232-1517
Mailing address
PO BOX 9359, 634 BEECH STREET, TERRE HAUTE, IN 47808-9359
(812) 244-0100
(812) 232-1517
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
50000920A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100284610A
—
IN
05
—
100284650A
—
IN
05
—
100284700
—
IN
05
—
100453080A
—
IN
05
—
100468870A
—
IN
05
—
100468890A
—
IN
05
—
200131840A
—
IN
Enumeration date
05/24/2005
Last updated
12/02/2010
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