NPIMap

Organization Active NPI

Cutaneous and Maxillofacial Pathology Laboratory, PC

  • Clinical Medical Laboratory
  • Indianapolis, IN
National Provider Identifier
1386717940
Registry record updated Jun 10, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
License
15D0647261 Issued in IN
Legal business name
CUTANEOUS AND MAXILLOFACIAL PATHOLOGY LABORATORY, PC
Practice address
9292 N. Meridian St.
Suite 210
Indianapolis, IN 46260-1828
Phone
(317) 843-2204
Fax
(317) 843-2478
NPI assigned
Nov 15, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2019

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

Authorized official

Name
Christy D. Lynn
Title
Billing Clerk
Phone
(317) 843-2204

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X 15D0647261 IN Primary
Clinical Medical Laboratory 291U00000X

Addresses

Primary practice location

9292 N. Meridian St.
Suite 210
Indianapolis, IN 46260-1828

Mailing address

9292 N. Meridian St.
Suite 210
Indianapolis, IN 46260-1828
Phone (317) 843-2204

Other identifiers 1

IdentifierTypeStateIssuer
100236370AMedicaidIN

Other names 1

  • Dermatopathology Laboratory Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20091102000261 IN Part B Supplier - Independent Clinical Laboratory 2365589892 Practice locations: Indianapolis, IN
O20230310002513 IN Part B Supplier - Clinic/Group Practice 2365589892 Receives reassigned benefits from 1 practitioner
Practice locations: Indianapolis, IN

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1163548800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1560124800000",
    "number": "1386717940",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9292 N. MERIDIAN ST.",
            "address_2": "SUITE 210",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462601828",
            "telephone_number": "317-843-2204",
            "fax_number": "317-843-2478"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9292 N. MERIDIAN ST.",
            "address_2": "SUITE 210",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462601828",
            "telephone_number": "317-843-2204",
            "fax_number": "317-843-2478"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CUTANEOUS AND MAXILLOFACIAL PATHOLOGY LABORATORY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-15",
        "last_updated": "2019-06-10",
        "status": "A",
        "authorized_official_last_name": "LYNN",
        "authorized_official_first_name": "CHRISTY",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "BILLING CLERK",
        "authorized_official_telephone_number": "317-843-2204"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "IN",
            "license": "15D0647261",
            "primary": true
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100236370A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dermatopathology Laboratory",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Dermatopathology Laboratory",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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 Jun 10, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.