NPIMap

Organization Active NPI

DCL Medical Laboratories, LLC

  • Clinical Medical Laboratory
  • Collinsville, IL
National Provider Identifier
1093879140
Registry record updated Oct 1, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
Legal business name
DCL MEDICAL LABORATORIES, LLC
Practice address
1616 East Port Plaza
Collinsville, IL 62234
Phone
(618) 343-0002
Fax
(317) 874-1440
NPI assigned
Dec 21, 2006
Last updated
Oct 1, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 1, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. James A Bucher
Title
VP of Finance
Phone
(317) 874-1297

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X Primary

Addresses

Primary practice location

1616 East Port Plaza
Collinsville, IL 62234

Mailing address

9550 Zionsville Rd
Indianapolis, IN 46268-1065
Phone (317) 874-1319

Other identifiers 2

IdentifierTypeStateIssuer
100237800MedicaidIN
351609041002MedicaidIL

Other names 1

  • Diagnostic Cytology Laboratories Inc Former legal business name

National Provider Directory

National Provider Directory
Tax ID family
DCL Medical Laboratories LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1166659200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1222819200000",
    "number": "1093879140",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9550 ZIONSVILLE RD",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462681065",
            "telephone_number": "317-874-1319",
            "fax_number": "317-874-1440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1616 EAST PORT PLAZA",
            "city": "COLLINSVILLE",
            "state": "IL",
            "postal_code": "62234",
            "telephone_number": "618-343-0002",
            "fax_number": "317-874-1440"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DCL MEDICAL LABORATORIES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-21",
        "last_updated": "2008-10-01",
        "status": "A",
        "authorized_official_last_name": "BUCHER",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "VP OF FINANCE",
        "authorized_official_telephone_number": "317-874-1297",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100237800",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "351609041002",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Diagnostic Cytology Laboratories Inc",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Collinsville, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.