Provider Demographics
NPI:1396538153
Name:FAMILIAR FACES CLINICAL LABORATORY
Entity type:Organization
Organization Name:FAMILIAR FACES CLINICAL LABORATORY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SASHA
Authorized Official - Middle Name:M
Authorized Official - Last Name:ODOM
Authorized Official - Suffix:
Authorized Official - Credentials:CCMA
Authorized Official - Phone:463-221-2605
Mailing Address - Street 1:2426 55TH PL
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-3502
Mailing Address - Country:US
Mailing Address - Phone:463-221-2605
Mailing Address - Fax:463-221-2507
Practice Address - Street 1:2426 55TH PL
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-3502
Practice Address - Country:US
Practice Address - Phone:463-221-2605
Practice Address - Fax:463-221-2507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-26
Last Update Date:2025-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes291U00000XLaboratoriesClinical Medical Laboratory
No247ZC0005XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyClinical Laboratory Director, Non-physicianGroup - Multi-Specialty