Provider Demographics
NPI:1083895783
Name:PROMAX LABORATORY
Entity Type:Organization
Organization Name:PROMAX LABORATORY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:B
Authorized Official - Last Name:CADY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-429-0772
Mailing Address - Street 1:4727 ROSEBUD LN
Mailing Address - Street 2:INTERSTATE OFFICE PARK
Mailing Address - City:NEWBURGH
Mailing Address - State:IN
Mailing Address - Zip Code:47630-9367
Mailing Address - Country:US
Mailing Address - Phone:812-429-0772
Mailing Address - Fax:812-429-0793
Practice Address - Street 1:4727 ROSEBUD LN
Practice Address - Street 2:INTERSTATE OFFICE PARK
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630-9367
Practice Address - Country:US
Practice Address - Phone:812-429-0772
Practice Address - Fax:812-429-0793
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CADY WELLNESS INSTITUTE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-21
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01041458291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory