MEDICARE: SSA VENTURES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215527668
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SSA VENTURES, LLC

Provider Business Mailing Address
First Line	:	7000 AIRPORT DR
Second Line	:
City	:	SELLERSBURG
State	:	IN
Zip	:	47172-2033
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1714 CHARLESTOWN NEW ALBANY RD
Second Line	:
City	:	JEFFERSONVILLE
State	:	IN
Zip	:	47130-9708
Country	:	US
Telephone Number	:	812-271-4240
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SHAWN HONAKER
Credential	:
Telephone Number	:	502-377-4751

Provider Enumeration Date	:	01/20/2021
Last Update Date	:	03/24/2022

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Directions to “SSA VENTURES, LLC ” Practice Location

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