Healthcare Provider Details

I. General information

NPI: 1063806776
Provider Name (Legal Business Name): AMERICAN DIAGNOSTICS SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2015
Last Update Date: 02/18/2020
Certification Date: 02/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1660 E MAIN ST SUITE 105
PLAINFIELD IN
46168-2811
US

IV. Provider business mailing address

6981 N PARK DR STE 506
PENNSAUKEN NJ
08109-4205
US

V. Phone/Fax

Practice location:
  • Phone: 317-839-2117
  • Fax:
Mailing address:
  • Phone: 856-317-0506
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code293D00000X
TaxonomyPhysiological 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: ANGELA M AMEY
Title or Position: VP REIMBURSEMENT
Credential:
Phone: 800-786-8015