Provider Demographics
NPI:1356722383
Name:LAB EXPRESS INDIANA INCORPORATED
Entity type:Organization
Organization Name:LAB EXPRESS INDIANA INCORPORATED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:VILLAFANAE
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:503-747-7427
Mailing Address - Street 1:10475 CROSSPOINT BLVD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-3386
Mailing Address - Country:US
Mailing Address - Phone:503-747-7427
Mailing Address - Fax:
Practice Address - Street 1:10475 CROSSPOINT BLVD
Practice Address - Street 2:SUITE 250
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-3386
Practice Address - Country:US
Practice Address - Phone:503-747-7427
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-16
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory