Provider Demographics
NPI:1215713789
Name:ESSENTIAL LAB SERVICES LLC
Entity type:Organization
Organization Name:ESSENTIAL LAB SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANGER
Authorized Official - Prefix:
Authorized Official - First Name:SHAWNISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-966-6298
Mailing Address - Street 1:7022 W 10TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46214-3528
Mailing Address - Country:US
Mailing Address - Phone:317-966-6298
Mailing Address - Fax:
Practice Address - Street 1:7022 W 10TH ST STE A
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46214-3528
Practice Address - Country:US
Practice Address - Phone:317-966-6298
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-31
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory