Provider Demographics
NPI:1619632007
Name:VITAL POINT MOBILE LAB SERVICES LLC
Entity Type:Organization
Organization Name:VITAL POINT MOBILE LAB SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHLEBOTOMIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANTOINETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-277-9033
Mailing Address - Street 1:611 MCKINLEY ST
Mailing Address - Street 2:
Mailing Address - City:GARY
Mailing Address - State:IN
Mailing Address - Zip Code:46404-1422
Mailing Address - Country:US
Mailing Address - Phone:708-277-9033
Mailing Address - Fax:
Practice Address - Street 1:611 MCKINLEY ST
Practice Address - Street 2:
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46404-1422
Practice Address - Country:US
Practice Address - Phone:708-277-9033
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-01
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory