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NPI Code Detail

MEDICARE: IMA INC LABORATORY

MEDICARE: IMA INC LABORATORY
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
1291U00000XClinical Medical Laboratory15D0360681IN

General Provider Information

NPI Number : 1588669667
Entity Type Code : Organization
Provider Name (Legal Business Name) : IMA INC LABORATORY
Provider Business Mailing Address
First Line : PO BOX 550
Second Line :
City : BLOOMINGTON
State : IN
Zip : 47402-0550
Country : US
Telephone Number : 812-331-3406
Fax Number : 812-334-0536
Provider Business Practice Location Address
First Line : 550 S LANDMARK AVE
Second Line :
City : BLOOMINGTON
State : IN
Zip : 47403-3239
Country : US
Telephone Number : 812-331-3406
Fax Number : 812-334-0536
Authorized Official
Title or Position : DIRECTOR OF LAB
Name : TOM F HRISOMALOS
Credential :
Telephone Number : 812-355-3406
Provider Enumeration Date : 06/16/2005
Last Update Date : 09/26/2008

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Directions to “IMA INC LABORATORY ” Practice Location

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