Provider Demographics
NPI:1154078541
Name:BERRY BEST MOBILE LAB SERVICES, LLC
Entity Type:Organization
Organization Name:BERRY BEST MOBILE LAB SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/ HEAD LAB TECHNICIAN
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:MONIQUE
Authorized Official - Last Name:ELLSBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:CPT
Authorized Official - Phone:954-822-4722
Mailing Address - Street 1:PO BOX 18641
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85731-8641
Mailing Address - Country:US
Mailing Address - Phone:954-822-4722
Mailing Address - Fax:
Practice Address - Street 1:325 W 2ND ST BLDG 2
Practice Address - Street 2:STE 108
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85705
Practice Address - Country:US
Practice Address - Phone:954-822-4722
Practice Address - Fax:866-420-8579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-04
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory