Provider Demographics
NPI:1578602157
Name:HEARTLAND REPRODUCTIVE BIOLOGY LAB
Entity Type:Organization
Organization Name:HEARTLAND REPRODUCTIVE BIOLOGY LAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:JARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-217-2525
Mailing Address - Street 1:11725 N ILLINOIS ST
Mailing Address - Street 2:SUITE #520
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032
Mailing Address - Country:US
Mailing Address - Phone:317-814-4172
Mailing Address - Fax:317-814-4131
Practice Address - Street 1:11725 N ILLINOIS ST
Practice Address - Street 2:SUITE #520
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032
Practice Address - Country:US
Practice Address - Phone:317-814-4172
Practice Address - Fax:317-814-4131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01033419A291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory