Provider Demographics
NPI:1285811919
Name:HOOSIER HISTOLOGY SERVICES
Entity type:Organization
Organization Name:HOOSIER HISTOLOGY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:MEDICAL DIRECTOR
Authorized Official - Phone:812-865-4475
Mailing Address - Street 1:8698 N COUNTY ROAD 200 E
Mailing Address - Street 2:
Mailing Address - City:ORLEANS
Mailing Address - State:IN
Mailing Address - Zip Code:47452-9503
Mailing Address - Country:US
Mailing Address - Phone:812-865-4475
Mailing Address - Fax:
Practice Address - Street 1:8698 N COUNTY ROAD 200 E
Practice Address - Street 2:
Practice Address - City:ORLEANS
Practice Address - State:IN
Practice Address - Zip Code:47452-9503
Practice Address - Country:US
Practice Address - Phone:812-865-4475
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-24
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN291U00000X291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory