Provider Demographics
NPI:1093879140
Name:DCL MEDICAL LABORATORIES, LLC
Entity Type:Organization
Organization Name:DCL MEDICAL LABORATORIES, LLC
Other - Org Name:DIAGNOSTIC CYTOLOGY LABORATORIES INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:VP OF FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:BUCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-874-1297
Mailing Address - Street 1:9550 ZIONSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-1065
Mailing Address - Country:US
Mailing Address - Phone:317-874-1319
Mailing Address - Fax:317-874-1440
Practice Address - Street 1:1616 EAST PORT PLAZA
Practice Address - Street 2:
Practice Address - City:COLLINSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62234
Practice Address - Country:US
Practice Address - Phone:618-343-0002
Practice Address - Fax:317-874-1440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100237800Medicaid
IL351609041002Medicaid
IN100237800Medicaid
IN824270BMedicare PIN