Healthcare Provider Details

I. General information

NPI: 1194840595
Provider Name (Legal Business Name): DCL MEDICAL LABORATORIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 11/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9550 ZIONSVILLE RD
INDIANAPOLIS IN
46268-1065
US

IV. Provider business mailing address

9550 ZIONSVILLE RD
INDIANAPOLIS IN
46268-1065
US

V. Phone/Fax

Practice location:
  • Phone: 800-377-9364
  • Fax:
Mailing address:
  • Phone: 800-377-9364
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY WILLIAMS
Title or Position: VP
Credential:
Phone: 317-874-1297