MEDICARE: INDIANA FERTILITY LABORATORY LLC

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	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1780059998
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INDIANA FERTILITY LABORATORY LLC

Provider Business Mailing Address
First Line	:	5000 MERIDIAN BLVD
Second Line	:	SUITE 250
City	:	FRANKLIN
State	:	TN
Zip	:	37067-6667
Country	:	US
Telephone Number	:	615-550-4900
Fax Number	:	615-550-4901

Provider Business Practice Location Address
First Line	:	10610 N PENNSYLVANIA ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46280-2004
Country	:	US
Telephone Number	:	617-575-6565
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DEBBIE JAMES
Credential	:
Telephone Number	:	615-550-7357

Provider Enumeration Date	:	12/14/2015
Last Update Date	:	12/14/2015

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