Provider Demographics
NPI:1154052900
Name:PROMINENT MOBILE LABS LLC
Entity Type:Organization
Organization Name:PROMINENT MOBILE LABS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TREZEST
Authorized Official - Middle Name:
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-297-9718
Mailing Address - Street 1:1910 MADISON AVE # 2032
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-2620
Mailing Address - Country:US
Mailing Address - Phone:901-610-2950
Mailing Address - Fax:888-251-2814
Practice Address - Street 1:1910 MADISON AVE # 2032
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-2620
Practice Address - Country:US
Practice Address - Phone:901-610-2950
Practice Address - Fax:888-251-2814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-22
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Single Specialty