Provider Demographics
NPI:1942863816
Name:MOBILE HEALTH TESTING SOUTIONS LLC
Entity Type:Organization
Organization Name:MOBILE HEALTH TESTING SOUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:GERARD
Authorized Official - Last Name:BOWEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-336-6655
Mailing Address - Street 1:2520 WITT RD
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:IN
Mailing Address - Zip Code:46052-9593
Mailing Address - Country:US
Mailing Address - Phone:765-336-6655
Mailing Address - Fax:765-482-7658
Practice Address - Street 1:2520 WITT RD
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:IN
Practice Address - Zip Code:46052-9593
Practice Address - Country:US
Practice Address - Phone:765-336-6655
Practice Address - Fax:765-482-7658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-17
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN8913684721OtherDL