Organization
FIRSTSOURCE LABORATORY SOLUTIONS, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WILLIAM B HAYES (CFO EVP TREASURER)
(317) 566-9846
Entity
Organization
Contact information
Practice address
10022 LANTERN RD STE 600, STE 600, FISHERS, IN 46037-9602
(317) 566-9846
Mailing address
PO BOX 2240, BURLINGTON, NC 27216-2240
(800) 222-7566
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
15D1031494
CLIA
—
Enumeration date
09/13/2010
Last updated
08/21/2013
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