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NPI Code Detail

MEDICARE: MID AMERICA CLINICAL LABORATORIES, LLC

MEDICARE: MID AMERICA CLINICAL LABORATORIES, 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
1291U00000XClinical Medical Laboratory15D0035621IN

General Provider Information

NPI Number : 1831502129
Entity Type Code : Organization
Provider Name (Legal Business Name) : MID AMERICA CLINICAL LABORATORIES, LLC
Provider Business Mailing Address
First Line : 2560 N SHADELAND AVE
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46219-1705
Country : US
Telephone Number : 317-803-1010
Fax Number : 317-803-0186
Provider Business Practice Location Address
First Line : 3700 WASHINGTON AVE
Second Line :
City : EVANSVILLE
State : IN
Zip : 47714-0542
Country : US
Telephone Number : 812-485-4344
Fax Number : 812-485-4017
Authorized Official
Title or Position : C.E.O./GENERAL MANAGER
Name : MRS. DIANNE Z. VANNESS
Credential :
Telephone Number : 317-803-1010
Provider Enumeration Date : 06/04/2014
Last Update Date : 06/04/2014

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Directions to “MID AMERICA CLINICAL LABORATORIES, LLC ” Practice Location

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