Labcorp Indiana Inc

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

LABCORP INDIANA INC

Practice address

530 N Lafayette Blvd FL 1
South Bend, IN 46601-1004

Phone

(574) 400-4247

NPI assigned

May 14, 2020

Organization subpart

No

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

Authorized official

Name

Kimberly T Williams

Title

Vice President

Phone

(800) 222-7566

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

Labcorp Indiana Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Labcorp Indiana Inc

  • Clinical Medical Laboratory
  • Burlington, NC
  • NPI 1336797711
  NPD tax ID

Locations

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

{
    "created_epoch": "1589414400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1589414400000",
    "number": "1801418751",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2240",
            "city": "BURLINGTON",
            "state": "NC",
            "postal_code": "272162240"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "530 N LAFAYETTE BLVD FL 1",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466011004",
            "telephone_number": "574-400-4247"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LABCORP INDIANA INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-05-14",
        "last_updated": "2020-05-14",
        "certification_date": "2020-05-14",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "800-222-7566"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "15D2179256",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rachelina Portolese Kvietkus, M.D.
• Joshua Eric Kwasnicka
• Zachary Kyle, MSW, LCSW
• L & L Caring Hands Home Care LLC
• Labcorp Indiana Inc
• Laboratory Corporation of America
• Laboratory Corporation of America Holdings
• Jennifer L. Lackman-Chuppe, MD
• Mary Regina Feeks Lacoursiere, DO
• Richard Lacoursiere

• Clinical Medical Laboratory in South Bend, IN
• Providers in South Bend, 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 May 14, 2020; 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.