Mid America Clinical Laboratories LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

MID AMERICA CLINICAL LABORATORIES LLC

Practice address

816 Dillon Dr
Richmond, IN 47374-8057

Phone

(765) 966-7056

Fax

(765) 966-6248

NPI assigned

Mar 16, 2007

Last updated

Dec 11, 2018By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Thomas Kmetz

Title

Cfo

Phone

(317) 803-1010

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• MACL Other name

Locations

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

{
    "created_epoch": "1174003200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1544486400000",
    "number": "1225152325",
    "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": "816 DILLON DR",
            "city": "RICHMOND",
            "state": "IN",
            "postal_code": "473748057",
            "telephone_number": "765-966-7056",
            "fax_number": "765-966-6248"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MID AMERICA CLINICAL LABORATORIES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-16",
        "last_updated": "2018-12-11",
        "status": "A",
        "authorized_official_last_name": "KMETZ",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "317-803-1010"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "15D1065629",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAP",
            "identifier": "7198828",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MACL",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "MACL",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Clinical Medical Laboratory in Richmond, IN
• Providers in Richmond, IN by specialty
• Clinical Medical Laboratory in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2018; 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.