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General NPI Number Information
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NPI Number | 1215516000
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Entity Type | Organization
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Legal Business Name | INFLAMMATORY MARKERS DIAGNOSTIC LABORATORY LLC
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Dates
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Enumeration Date | 04/07/2021
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Last Update Date | 01/25/2023
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Provider Practice Location Address
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Address Line | 9412 E CENTRAL AVE
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City | WICHITA
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State | KS
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Zip | 67206-2540
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Country | US
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Telephone | 316-558-5850
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Fax | 888-494-1636
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Provider Business Mailing Address
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Address Line | 9412 E CENTRAL AVE
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City | WICHITA
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State | KS
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Zip | 67206-2540
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Country | US
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Telephone | 316-558-5850
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Fax | 316-558-5789
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Authorized Official
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Title or Position | LAB DIRECTOR
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Name | CHARLES T HINSHAW
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Credential | MD
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Telephone | 316-558-5850
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZP0105X
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Taxonomy Name | Clinical Pathology/Laboratory Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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