NPI 1134699945

Executive Diagnostics LLC

Organisation Clinical Medical Laboratory Jackson, MS

Practice location

Address: 5455 Executive Pl STE B, Jackson, MS 39206-4104
Phone: (219) 395-0667
Mailing address: 10996 Four Seasons Pl STE 100a, Crown Point, IN 46307-8685

Authorised official

Name: Kirnjot Singh
Title: President
Phone: (219) 395-0667

Registered specialties

Clinical Medical Laboratory Primary

Laboratories Taxonomy 291U00000X

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Registry record

NPI: 1134699945
Entity type: Organization
NPI issued: 5 Dec 2018
Record last updated: 5 Dec 2018

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.