Provider Demographics
NPI:1386181964
Name:ON THE GO LABS LLC
Entity Type:Organization
Organization Name:ON THE GO LABS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHLEBOTOMIST
Authorized Official - Prefix:
Authorized Official - First Name:SHONTA
Authorized Official - Middle Name:N
Authorized Official - Last Name:BRENSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-812-3092
Mailing Address - Street 1:1323 NW HIDDEN RIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:BLUE SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64015-2719
Mailing Address - Country:US
Mailing Address - Phone:816-812-3092
Mailing Address - Fax:
Practice Address - Street 1:1323 NW HIDDEN RIDGE CIR
Practice Address - Street 2:
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64015-2719
Practice Address - Country:US
Practice Address - Phone:816-812-3092
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-20
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO246RP1900X246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Single Specialty