Healthcare Provider Details

I. General information

NPI: 1720570708
Provider Name (Legal Business Name): UNITED STATES MEDICAL LABORATORY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2018
Last Update Date: 10/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3684 HIGHWAY 150 STE 2
FLOYDS KNOBS IN
47119-9692
US

IV. Provider business mailing address

3684 HIGHWAY 150 STE 2
FLOYDS KNOBS IN
47119-9692
US

V. Phone/Fax

Practice location:
  • Phone: 812-728-8202
  • Fax:
Mailing address:
  • Phone: 812-728-8202
  • Fax: 812-670-5334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: BRANISLAVA MATEVICH
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 812-728-8202