Organization
OUTREACH MOBILE LAB, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEMETRIA BUCKNER MA (MANAGER)
(317) 567-1293
Entity
Organization
Contact information
Practice address
5901 WALSHAM WAY, INDIANAPOLIS, IN 46254
(317) 567-1293
Mailing address
3250 A. WEST 86TH ST #1289, INDIANAPOLIS, IN 46268-3605
(317) 567-1293
(317) 981-3979
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
—
—
174H00000X
Health Educator
—
—
246RP1900X
Phlebotomy Technician
Primary
—
—
Other
Enumeration date
03/05/2024
Last updated
03/05/2024
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