Provider Demographics
NPI:1720570708
Name:UNITED STATES MEDICAL LABORATORY
Entity Type:Organization
Organization Name:UNITED STATES MEDICAL LABORATORY
Other - Org Name:US MED LAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:BRANISLAVA
Authorized Official - Middle Name:
Authorized Official - Last Name:MATEVICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-728-8202
Mailing Address - Street 1:3684 HIGHWAY 150 STE 2
Mailing Address - Street 2:
Mailing Address - City:FLOYDS KNOBS
Mailing Address - State:IN
Mailing Address - Zip Code:47119-9692
Mailing Address - Country:US
Mailing Address - Phone:812-728-8202
Mailing Address - Fax:812-670-5334
Practice Address - Street 1:3684 HIGHWAY 150 STE 2
Practice Address - Street 2:
Practice Address - City:FLOYDS KNOBS
Practice Address - State:IN
Practice Address - Zip Code:47119-9692
Practice Address - Country:US
Practice Address - Phone:812-728-8202
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-05
Last Update Date:2018-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory