Provider Demographics
NPI:1922883438
Name:BAILEY'S MOBILE LAB
Entity Type:Organization
Organization Name:BAILEY'S MOBILE LAB
Other - Org Name:BAILEY'S MOBILE LAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LASHELL
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-636-3809
Mailing Address - Street 1:310 MID CONTINENT PLZ STE 604D
Mailing Address - Street 2:
Mailing Address - City:WEST MEMPHIS
Mailing Address - State:AR
Mailing Address - Zip Code:72301-1763
Mailing Address - Country:US
Mailing Address - Phone:870-636-3809
Mailing Address - Fax:
Practice Address - Street 1:310 MID CONTINENT PLZ STE 604D
Practice Address - Street 2:
Practice Address - City:WEST MEMPHIS
Practice Address - State:AR
Practice Address - Zip Code:72301-1763
Practice Address - Country:US
Practice Address - Phone:870-636-3809
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-31
Last Update Date:2023-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service