Organization
MID AMERICA CLINICAL LABORATORIES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS KMETZ (CFO)
(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
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
15D0665318
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
15D0665318
CLIA
IN
05
—
200188040A
—
IN
01
—
CAP
1681301
IN
Enumeration date
03/20/2006
Last updated
12/11/2018
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