Organization
MID AMERICA CLINICAL LABORATORIES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DIANNE Z. VANNESS (CEO/GENERAL MANAGER)
(317) 803-1010
Entity
Organization
Contact information
Practice address
301 HENRY ST, NORTH VERNON, IN 47265-1030
(812) 352-4270
(812) 352-4202
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
15D0686555
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
15D0686555
CLIA
IN
01
—
7524362
CAP
IN
Enumeration date
02/28/2014
Last updated
02/28/2014
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