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Organization

LIBERTY LABORATORY INC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
VERONICA PEREZ (DELEGATE)
(812) 548-0086
Entity
Organization

Contact information

Practice address
1317 119TH ST, WHITING, IN 46394-1602
(219) 629-4030
(708) 488-1831
Mailing address
4531 HARRISON ST, HILLSIDE, IL 60162-1614
(812) 619-0413
(708) 318-4182

Taxonomy

Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
15D1019268
IN
291U00000X
Clinical Medical Laboratory

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000311554
BCBS NUMBER
IN
05
300024950
IN
Enumeration date
12/19/2005
Last updated
05/08/2024
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