Provider Demographics
NPI:1033864467
Name:ACCUMARK DIAGNOSTICS LLC
Entity Type:Organization
Organization Name:ACCUMARK DIAGNOSTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:LANNING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-480-1832
Mailing Address - Street 1:381 N 700 E
Mailing Address - Street 2:
Mailing Address - City:GREENTOWN
Mailing Address - State:IN
Mailing Address - Zip Code:46936-1058
Mailing Address - Country:US
Mailing Address - Phone:765-480-1832
Mailing Address - Fax:
Practice Address - Street 1:115 W MAIN ST
Practice Address - Street 2:
Practice Address - City:GREENTOWN
Practice Address - State:IN
Practice Address - Zip Code:46936-1116
Practice Address - Country:US
Practice Address - Phone:765-627-4003
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-14
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory