Organization
MID AMERICA CLINICAL LABORATORIES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DIANNE Z. VANNESS (CEO/GENERAL MANAGER)
(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
473 E GREENVILLE AVE, WINCHESTER, IN 47394-9436
(765) 584-0328
(765) 584-0333
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
15D0360519
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
15D0360519
CLIA
IN
Enumeration date
09/30/2013
Last updated
09/30/2013
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