Healthcare Provider Details

I. General information

NPI: 1093879140
Provider Name (Legal Business Name): DCL MEDICAL LABORATORIES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 10/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1616 EAST PORT PLAZA
COLLINSVILLE IL
62234
US

IV. Provider business mailing address

9550 ZIONSVILLE RD
INDIANAPOLIS IN
46268-1065
US

V. Phone/Fax

Practice location:
  • Phone: 618-343-0002
  • Fax: 317-874-1440
Mailing address:
  • Phone: 317-874-1319
  • Fax: 317-874-1440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MR. JAMES A BUCHER
Title or Position: VP OF FINANCE
Credential:
Phone: 317-874-1297