Provider Demographics
NPI:1942800685
Name:SOUTHERN MOBILE LABS
Entity Type:Organization
Organization Name:SOUTHERN MOBILE LABS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHLEBOTOMIST
Authorized Official - Prefix:
Authorized Official - First Name:JANIS
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SPURLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-457-3591
Mailing Address - Street 1:4132 RENOVA AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34286-4281
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4132 RENOVA AVE
Practice Address - Street 2:
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34286-4281
Practice Address - Country:US
Practice Address - Phone:941-457-3591
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-30
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Multi-Specialty