Healthcare Provider Details

I. General information

NPI: 1215844360
Provider Name (Legal Business Name): LOVE LEGACY MOBILE LAB SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1653 PARK RIDGE WAY
INDIANAPOLIS IN
46229-4122
US

IV. Provider business mailing address

1653 PARK RIDGE WAY
INDIANAPOLIS IN
46229-4122
US

V. Phone/Fax

Practice location:
  • Phone: 317-525-9765
  • Fax: 517-317-6531
Mailing address:
  • Phone: 317-525-9765
  • Fax: 517-317-6531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State

VIII. Authorized Official

Name: DAVID MOSLEY
Title or Position: OWNER
Credential: MOSLEY
Phone: 317-552-8829