Provider Demographics
NPI:1023207925
Name:EASTSIDE DIAGNOSTICS, INC.
Entity type:Organization
Organization Name:EASTSIDE DIAGNOSTICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:GRABINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:317-897-9949
Mailing Address - Street 1:PO BOX 199024
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-9024
Mailing Address - Country:US
Mailing Address - Phone:317-897-4494
Mailing Address - Fax:317-897-5490
Practice Address - Street 1:8163 E 21ST ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219-2513
Practice Address - Country:US
Practice Address - Phone:317-897-4494
Practice Address - Fax:317-897-5490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-17
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory