Provider Demographics
NPI:1881655090
Name:ARNETT CLINIC, LLC
Entity Type:Organization
Organization Name:ARNETT CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:
Authorized Official - First Name:ALFONSO
Authorized Official - Middle Name:
Authorized Official - Last Name:GATMAITAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-448-8000
Mailing Address - Street 1:PO BOX 5545
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47903-5545
Mailing Address - Country:US
Mailing Address - Phone:765-448-8000
Mailing Address - Fax:
Practice Address - Street 1:2600 GREENBUSH ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47904-2477
Practice Address - Country:US
Practice Address - Phone:765-448-8000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ARNETT CLINIC, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-03-29
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000377073OtherANTHEM LAB NUMBER
IN100232370AMedicaid
IN100232370AMedicaid
IN000000377073OtherANTHEM LAB NUMBER
IN815760Medicare PIN