Outreach Mobile Lab, LLC

Primary specialty

Phlebotomy TechnicianTaxonomy code 246RP1900X

Legal business name

OUTREACH MOBILE LAB, LLC

Practice address

5901 Walsham Way
Indianapolis, IN 46254

Phone

(317) 567-1293

NPI assigned

Mar 5, 2024

Organization subpart

No

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

Authorized official

Name

Demetria Buckner, MANPI 1346581949

Title

Manager

Phone

(317) 567-1293

Specialties & licenses 3

Addresses

Practitioners 1

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

• Demetria Buckner, BS HEALTH SCIENCES,

  • Phlebotomy Technician
  • Indianapolis, IN
  • NPI 1346581949

  Community Health Worker

  NPD (past) Authorized official

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

{
    "created_epoch": "1709596800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709596800000",
    "number": "1700643764",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3250 A. WEST 86TH ST #1289",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462683605",
            "telephone_number": "317-567-1293",
            "fax_number": "317-981-3979"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5901 WALSHAM WAY",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "46254",
            "telephone_number": "317-567-1293"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OUTREACH MOBILE LAB, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-03-05",
        "last_updated": "2024-03-05",
        "status": "A",
        "authorized_official_last_name": "BUCKNER",
        "authorized_official_first_name": "DEMETRIA",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "317-567-1293",
        "authorized_official_credential": "MA"
    },
    "taxonomies": [
        {
            "code": "172V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Community Health Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "174H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Health Educator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "246RP1900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Technician, Pathology, Phlebotomy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Margiy M Outten
• Carmen Heidy Ovando, MSW,LSW
• Over the Moon Home Care LLC
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• Phlebotomy Technician in Indianapolis, IN
• Providers in Indianapolis, IN by specialty
• Phlebotomy Technician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2024; 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.