NPIMap

Organization Active NPI

Mid America Clinical Laboratories, LLC

  • Clinical Medical Laboratory
  • Indianapolis, IN
National Provider Identifier
1104885052
Registry record updated Sep 16, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
License
15D1011663 Issued in IN
Legal business name
MID AMERICA CLINICAL LABORATORIES, LLC
Practice address
1950 W 86TH St
Suite 100
Indianapolis, IN 46260-2076
Phone
(317) 803-0330
Fax
(317) 334-0709
NPI assigned
Mar 20, 2006
Last updated
Sep 16, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 16, 2008

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

Authorized official

Name
Ms. Dianne Z. Vanness
Title
C.E.O./General Manager
Phone
(317) 803-0300

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X 15D1011663 IN Primary

Addresses

Primary practice location

1950 W 86TH St
Suite 100
Indianapolis, IN 46260-2076

Mailing address

2560 N Shadeland Ave
P.O. Box 19163
Indianapolis, IN 46219-1705
Phone (317) 803-1010

Other identifiers 3

IdentifierTypeStateIssuer
200188040DMedicaidIN
7183102OtherINCAP
15D1011663OtherINCLIA

National Provider Directory

National Provider Directory
Tax ID family
Mid America Clinical Laboratories LLC10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

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

Locations

1950 W 86th St
Ste 100
Indianapolis, IN 46260
Phone (317) 803-0330

NPI Registry JSON

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

{
    "created_epoch": "1142812800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1221523200000",
    "number": "1104885052",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2560 N SHADELAND AVE",
            "address_2": "P.O. BOX 19163",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462191705",
            "telephone_number": "317-803-1010",
            "fax_number": "317-803-0186"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1950 W 86TH ST",
            "address_2": "SUITE 100",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462602076",
            "telephone_number": "317-803-0330",
            "fax_number": "317-334-0709"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MID AMERICA CLINICAL LABORATORIES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-20",
        "last_updated": "2008-09-16",
        "status": "A",
        "authorized_official_last_name": "VANNESS",
        "authorized_official_first_name": "DIANNE",
        "authorized_official_middle_name": "Z.",
        "authorized_official_title_or_position": "C.E.O./GENERAL MANAGER",
        "authorized_official_telephone_number": "317-803-0300",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "IN",
            "license": "15D1011663",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200188040D",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAP",
            "identifier": "7183102",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "15D1011663",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Indianapolis, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 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.