Organization
PA LABS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GEORGE BRANAM M.D. (MEDICAL DIRECTOR)
(765) 284-7795
Entity
Organization
Contact information
Practice address
2401 W UNIVERSITY AVE, MUNCIE, IN 47303-3428
(765) 284-7795
(765) 741-5608
Mailing address
1200 W WHITE RIVER BLVD, MUNCIE, IN 47303-4988
(765) 741-5608
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000012322
M PLAN
IN
01
—
000000255389
ANTHEM BC/BS
IN
01
—
1686
PHYSICIAN HEALTH PLAN
IN
05
—
2099563
—
OH
Enumeration date
06/12/2006
Last updated
08/22/2020
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