Provider Demographics
NPI:1083388235
Name:1ST MOBILE MEDICAL TESTING, LLC
Entity Type:Organization
Organization Name:1ST MOBILE MEDICAL TESTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:WAMEL
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:575-496-5551
Mailing Address - Street 1:989 IVYDALE DR
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88005-0927
Mailing Address - Country:US
Mailing Address - Phone:575-496-5551
Mailing Address - Fax:
Practice Address - Street 1:989 IVYDALE DR
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005-0927
Practice Address - Country:US
Practice Address - Phone:575-496-5551
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-02
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Multi-Specialty
No261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, MobileGroup - Multi-Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty