Provider Demographics
NPI:1922386325
Name:DCL PATHOLOGY LLC
Entity Type:Organization
Organization Name:DCL PATHOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LAB DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:CAROL
Authorized Official - Last Name:EISENHUT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-874-1254
Mailing Address - Street 1:9550 ZIONSVILLE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-1065
Mailing Address - Country:US
Mailing Address - Phone:317-874-1254
Mailing Address - Fax:317-872-4193
Practice Address - Street 1:9550 ZIONSVILLE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46268-1065
Practice Address - Country:US
Practice Address - Phone:317-874-1254
Practice Address - Fax:317-872-4193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-02
Last Update Date:2012-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH05822083Medicaid
KY7100181920Medicaid
IN201050900AMedicaid
INM300056658Medicare PIN
IN201050900AMedicaid