Provider Demographics
NPI:1699852772
Name:HCMH DIVERSIFIED MANAGEMENT CORP INC
Entity Type:Organization
Organization Name:HCMH DIVERSIFIED MANAGEMENT CORP INC
Other - Org Name:HCMH DIVERSIFIED PROF LAB
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:F
Authorized Official - Last Name:JANSSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-521-1508
Mailing Address - Street 1:PO BOX 653
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:IN
Mailing Address - Zip Code:47362-0653
Mailing Address - Country:US
Mailing Address - Phone:765-521-1366
Mailing Address - Fax:765-521-1555
Practice Address - Street 1:2200 FOREST RIDGE PARKWAY
Practice Address - Street 2:SUITE 300
Practice Address - City:NEW CASTLE
Practice Address - State:IN
Practice Address - Zip Code:47362-2943
Practice Address - Country:US
Practice Address - Phone:765-521-1366
Practice Address - Fax:765-521-1555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000097943OtherANTHEM
IN983400Medicare PIN