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
1321 UNITY PL, SUITE B, LAFAYETTE, IN 47905-5793
(317) 803-1010
(317) 803-0186
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
15D1029535
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
15D1029535
CLIA
IN
01
—
719071402
CAP
IN
Enumeration date
11/15/2012
Last updated
11/15/2012
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