NPIMap

Organization Active NPI

Mid America Clinical Laboratories, LLC

  • Clinical Medical Laboratory
  • Indianapolis, IN
National Provider Identifier
1699189704
Registry record updated Jun 17, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
License
15D0354030 Issued in IN
Legal business name
MID AMERICA CLINICAL LABORATORIES, LLC
Practice address
3630 Guion Rd
Indianapolis, IN 46222-1616
Phone
(317) 920-7370
Fax
(317) 803-0186
NPI assigned
Jun 17, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 17, 2014

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

Authorized official

Name
Mrs. Dianne Z. Vanness
Title
C.E.O./General Manager
Phone
(317) 803-1010

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X 15D0354030 IN Primary

Addresses

Primary practice location

3630 Guion Rd
Indianapolis, IN 46222-1616

Mailing address

2560 N Shadeland Ave
Indianapolis, IN 46219-1705
Phone (317) 803-1010

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.

NPI Registry JSON

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

{
    "created_epoch": "1402963200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1402963200000",
    "number": "1699189704",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2560 N SHADELAND AVE",
            "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": "3630 GUION RD",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462221616",
            "telephone_number": "317-920-7370",
            "fax_number": "317-803-0186"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MID AMERICA CLINICAL LABORATORIES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-17",
        "last_updated": "2014-06-17",
        "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": "317-803-1010",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "IN",
            "license": "15D0354030",
            "primary": true
        }
    ],
    "identifiers": [],
    "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 Jun 17, 2014; 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.