Provider Demographics
NPI:1558430439
Name:MOBILE BIOPSY LLC
Entity Type:Organization
Organization Name:MOBILE BIOPSY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:L
Authorized Official - Last Name:HOGLUND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-872-3265
Mailing Address - Street 1:164 BAYMOUNT DRIVE
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28625
Mailing Address - Country:US
Mailing Address - Phone:704-872-3265
Mailing Address - Fax:704-872-5823
Practice Address - Street 1:208 OLD MOCKSVILLE ROAD
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28625
Practice Address - Country:US
Practice Address - Phone:704-872-3265
Practice Address - Fax:704-872-5823
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty