Provider Demographics
NPI:1194840595
Name:DCL MEDICAL LABORATORIES LLC
Entity Type:Organization
Organization Name:DCL MEDICAL LABORATORIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
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:800-377-9364
Mailing Address - Fax:
Practice Address - Street 1:9550 ZIONSVILLE RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46268-1065
Practice Address - Country:US
Practice Address - Phone:800-377-9364
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2013-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes291U00000XLaboratoriesClinical Medical Laboratory
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Multi-Specialty
No207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP00443907OtherRAILROAD MEDICARE
IN000000550555OtherANTHEM BCBS
ILDG6017OtherRAILROAD MEDICARE
IL06032266OtherBCBS IL
CB9306OtherRAILROAD MEDICARE
CF9854OtherRAILROAD MEDICARE
IL08222860OtherBCBS IL
IN200405290AMedicaid
ILP00466399OtherRAILROAD MEDICARE
IN200884260AMedicaid
INDG7215OtherRAILROAD MEDICARE
INDG7215OtherRAILROAD MEDICARE
ILP00466399OtherRAILROAD MEDICARE
IL=========002Medicaid
CB9306OtherRAILROAD MEDICARE
CF9854OtherRAILROAD MEDICARE
IL=========002Medicaid
ILDG6017OtherRAILROAD MEDICARE
IL=========003Medicaid
IN200405290AMedicaid