Healthcare Provider Details

I. General information

NPI: 1255494761
Provider Name (Legal Business Name): M-TECH LAB, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 03/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8653 BASH ST
INDIANAPOLIS IN
46256-1202
US

IV. Provider business mailing address

8653 BASH ST
INDIANAPOLIS IN
46256-1202
US

V. Phone/Fax

Practice location:
  • Phone: 317-915-7553
  • Fax: 317-915-7559
Mailing address:
  • Phone: 317-915-7553
  • Fax: 317-915-7559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name: MR. THOMAS OLIVER MILLER
Title or Position: PRESIDENT
Credential:
Phone: 317-915-7553