Provider Demographics
NPI:1881642395
Name:FRANCISCAN CARDIOVASCULAR LABORATORY, LLC
Entity Type:Organization
Organization Name:FRANCISCAN CARDIOVASCULAR LABORATORY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CATH LAB MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:VANCE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:317-893-1922
Mailing Address - Street 1:5330 EAST STOP 11 ROAD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46237
Mailing Address - Country:US
Mailing Address - Phone:317-893-1920
Mailing Address - Fax:317-893-1921
Practice Address - Street 1:5330 EAST STOP 11 ROAD
Practice Address - Street 2:SUITE 101
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237
Practice Address - Country:US
Practice Address - Phone:317-893-1920
Practice Address - Fax:317-893-1921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
INBF9416618OtherDEA NUMBER
INBF9416618OtherDEA NUMBER
IN232960Medicare PIN