Provider Demographics
NPI:1447422167
Name:MOBILE LABORATORY HEALTH SERVICES
Entity Type:Organization
Organization Name:MOBILE LABORATORY HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:BOTTENFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:CLPLB
Authorized Official - Phone:208-946-6746
Mailing Address - Street 1:110 N. THIRD AVE.
Mailing Address - Street 2:
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864
Mailing Address - Country:US
Mailing Address - Phone:208-946-6746
Mailing Address - Fax:188-832-0983
Practice Address - Street 1:110 N. THIRD AVE.
Practice Address - Street 2:
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864
Practice Address - Country:US
Practice Address - Phone:208-946-6746
Practice Address - Fax:188-832-0983
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-02
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health