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General NPI Number Information
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NPI Number | 1265755136
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Entity Type | Organization
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Legal Business Name | INDIANA STATE DEPARTMENT OF HEALTH
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Dates
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Enumeration Date | 03/08/2010
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Last Update Date | 09/16/2020
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Provider Practice Location Address
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Address Line | 550 W 16TH STREET SUTIE B
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City | INDIANAPOLIS
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State | IN
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Zip | 46202-7804
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Country | US
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Telephone | 317-921-5500
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Fax | 317-927-7801
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Provider Business Mailing Address
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Address Line | 550 W 16TH STREET SUTIE B
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City | INDIANAPOLIS
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State | IN
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Zip | 46202-7804
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Country | US
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Telephone | 317-921-5500
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Fax | 317-927-7801
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Authorized Official
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Title or Position | LABORATORY DIRECTOR
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Name | DR. LIXIA LIU
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Credential | PH.D., D(ABMM)
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Telephone | 317-921-8509
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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