Provider Demographics
NPI:1497700967
Name:LABORATORY SERVICES OF INDIANA
Entity Type:Organization
Organization Name:LABORATORY SERVICES OF INDIANA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LABORATORY MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:MOWERY
Authorized Official - Suffix:
Authorized Official - Credentials:MT(ASCP)
Authorized Official - Phone:812-477-3977
Mailing Address - Street 1:955 S HEBRON AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47714-4085
Mailing Address - Country:US
Mailing Address - Phone:812-477-3977
Mailing Address - Fax:812-477-4506
Practice Address - Street 1:955 S HEBRON AVE
Practice Address - Street 2:SUITE C
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714-4085
Practice Address - Country:US
Practice Address - Phone:812-477-3977
Practice Address - Fax:812-477-4506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000222914OtherANTHEM BCBS
IN000000222914OtherANTHEM BCBS