Provider Demographics
NPI:1689237315
Name:MOBILE LAB SERVICES
Entity Type:Organization
Organization Name:MOBILE LAB SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HUNTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-946-0097
Mailing Address - Street 1:PO BOX 47
Mailing Address - Street 2:
Mailing Address - City:PECKS MILL
Mailing Address - State:WV
Mailing Address - Zip Code:25547-0047
Mailing Address - Country:US
Mailing Address - Phone:304-946-0097
Mailing Address - Fax:
Practice Address - Street 1:102 SPRING BEAUTY LANE
Practice Address - Street 2:
Practice Address - City:LAKE
Practice Address - State:WV
Practice Address - Zip Code:25121
Practice Address - Country:US
Practice Address - Phone:304-601-3554
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-18
Last Update Date:2019-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
No251E00000XAgenciesHome Health