Organization
MID AMERICA CLINICAL LABORATORIES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DIANNE Z. VANNESS (C.E.O./GENERAL MANAGER)
(317) 803-0300
Entity
Organization
Contact information
Practice address
1475 E STATE ROAD 44, CONNERSVILLE, IN 47331-8292
(765) 825-4460
(765) 827-8490
Mailing address
2560 N SHADELAND AVE, P.O. BOX 19163, INDIANAPOLIS, IN 46219-1705
(317) 803-1010
(317) 803-0186
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
15D0999249
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
15D0999249
CLIA
IN
05
—
200188040C
—
IN
01
—
7178952
CAP
IN
Enumeration date
03/20/2006
Last updated
09/16/2008
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