Provider Demographics
NPI:1780059998
Name:INDIANA FERTILITY LABORATORY LLC
Entity type:Organization
Organization Name:INDIANA FERTILITY LABORATORY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-550-7357
Mailing Address - Street 1:5000 MERIDIAN BLVD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-6667
Mailing Address - Country:US
Mailing Address - Phone:615-550-4900
Mailing Address - Fax:615-550-4901
Practice Address - Street 1:10610 N PENNSYLVANIA ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46280-2004
Practice Address - Country:US
Practice Address - Phone:617-575-6565
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INDIANA FERTILITY ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-12-14
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory