Provider Demographics
NPI:1336534718
Name:INDIANA CLINICAL LABORATORIES, LLC
Entity Type:Organization
Organization Name:INDIANA CLINICAL LABORATORIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRICIPAL
Authorized Official - Prefix:MR
Authorized Official - First Name:VIPIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ALDHLAKHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-233-0655
Mailing Address - Street 1:5635 W 96TH ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46278-6011
Mailing Address - Country:US
Mailing Address - Phone:301-233-0655
Mailing Address - Fax:
Practice Address - Street 1:5635 W 96TH ST
Practice Address - Street 2:SUITE 300
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46278-6011
Practice Address - Country:US
Practice Address - Phone:301-233-0655
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-01
Last Update Date:2015-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory