Organization
MID AMERICA CLINICAL LABORATORIES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DIANNE Z. VANNESS (C.E.O./GENERAL MANAGER)
(317) 803-1010
Entity
Organization
Contact information
Practice address
412 N MONROE ST, WILLIAMSPORT, IN 47993-1049
(765) 762-4072
(765) 762-4197
Mailing address
2560 N SHADELAND AVE, INDIANAPOLIS, IN 46219-1705
(317) 803-1010
(317) 803-0186
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
15D0035759
IN
Other
Enumeration date
06/04/2014
Last updated
06/04/2014
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