Provider Demographics
NPI:1508275082
Name:INDUSTRY LAB DIAGNOSTIC PARTNERS LLC
Entity Type:Organization
Organization Name:INDUSTRY LAB DIAGNOSTIC PARTNERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:
Authorized Official - First Name:TROY
Authorized Official - Middle Name:L
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-866-7922
Mailing Address - Street 1:9363 ALLEN RD STE B
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-3846
Mailing Address - Country:US
Mailing Address - Phone:513-866-7922
Mailing Address - Fax:513-860-0373
Practice Address - Street 1:INDUSTRY LAB DIAGNOSTIC PARTNERS
Practice Address - Street 2:9363 ALLEN RD STE B
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069
Practice Address - Country:US
Practice Address - Phone:513-866-7922
Practice Address - Fax:513-860-0373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-08
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN44D2080450291U00000X
291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN=========OtherEIN
OH36D2180180OtherCLIA