Provider Demographics
NPI:1477213387
Name:MOBILE STAT LAB SOLUTIONS
Entity Type:Organization
Organization Name:MOBILE STAT LAB SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KANIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:PBT
Authorized Official - Phone:440-453-0347
Mailing Address - Street 1:135 PARK MEADOW LN APT H
Mailing Address - Street 2:
Mailing Address - City:ELYRIA
Mailing Address - State:OH
Mailing Address - Zip Code:44035-7341
Mailing Address - Country:US
Mailing Address - Phone:440-453-0347
Mailing Address - Fax:
Practice Address - Street 1:135 PARK MEADOW LN APT H
Practice Address - Street 2:
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-7341
Practice Address - Country:US
Practice Address - Phone:440-453-0347
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-20
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Single Specialty