MEDICARE: VERIFIED & VETTED COMPREHENSIVE TESTING AND SCREENING SOLUTIONS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center
2	261QH0100X	Health Service Clinic/Center

General Provider Information

NPI Number	:	1477394369
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VERIFIED & VETTED COMPREHENSIVE TESTING AND SCREENING SOLUTIONS

Provider Business Mailing Address
First Line	:	5450 LAFAYETTE RD STE 7
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46254-1655
Country	:	US
Telephone Number	:	463-206-9070
Fax Number	:	872-266-4374

Provider Business Practice Location Address
First Line	:	5450 LAFAYETTE RD STE 7
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46254-1655
Country	:	US
Telephone Number	:	463-206-9070
Fax Number	:	872-266-4374

Authorized Official
Title or Position	:	DIRECTOR
Name	:	JOHARI COX
Credential	:	CPT
Telephone Number	:	463-206-9070

Provider Enumeration Date	:	06/04/2024
Last Update Date	:	10/02/2024

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