Provider Demographics
NPI:1902803745
Name:ACCUSTAT MEDICAL LAB, INC.
Entity Type:Organization
Organization Name:ACCUSTAT MEDICAL LAB, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY/TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:W
Authorized Official - Last Name:GREER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-248-3870
Mailing Address - Street 1:1811 EXECUTIVE DR
Mailing Address - Street 2:SUITE F
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46241-4300
Mailing Address - Country:US
Mailing Address - Phone:317-248-3870
Mailing Address - Fax:317-248-3885
Practice Address - Street 1:1811 EXECUTIVE DR
Practice Address - Street 2:SUITE F
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46241-4300
Practice Address - Country:US
Practice Address - Phone:317-248-3870
Practice Address - Fax:317-248-3885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20647335V00000X
IN291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
Not Answered291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN982060Medicare ID - Type Unspecified
IN096000Medicare ID - Type Unspecified